- Job Summary : The RN-Case Manager is responsible for utilization management and inpatient care management in a telephonic and / or onsite care management position;
- performs reviews of inpatient and outpatient services to determine medical appropriateness following evaluation of medical guidelines and benefit determination;
focuses on changing from retrospective, episodic case management to a prospective system of health maintenance, disease prevention and complex case management.
Through multidisciplinary collaboration, care is individualized to enhance achievement of mutually set goals and assure effective and efficient use of resources within fiscal realities.
Serves as the link between the patient in the community and the primary care physician to promote seamless, quality care that enhances quality of life.
The Case Manager-RN will participate in on-call rotation after-hours and / or on weekends as needed to meet contractual obligations and provide decision support for managed care issues.
Performs other duties as needed.
Education and Experience : High School Diploma or GED required. Bachelor's Degree in Nursing preferred. Minimum three years of experience as a Registered Nurse required.
Minimum two years of case management experience required.
Knowledge and Skills : Knowledge of patient care management principles and practices. Evaluation and assessment methodologies to identify functional, social, psychological, environmental, learning, and financial needs of patients.
- Able to read; write legibly; speak in English (and Spanish preferred) with professional quality; use computer and software programs necessary to the position;
- troubleshoot and calibrate patient care equipment. Relate and communicate positively, effectively, and professionally with others;
- be assertive and consistent in following and / or enforcing policies; work calmly and respond courteously when under pressure;
- lead, supervise, teach, and collaborate; accept direction. Communicate effectively in English in person, in writing, and on the telephone;
- think critically; work independently with minimal supervision; perform basic math functions; manage multiple assignments effectively;
work well under pressure; problem solve; organize and prioritize workload; recall information with accuracy; pay close attention to detail.
- Distinguish colors and smells as necessary for patient care; hear sufficiently for general conversation in person and on the telephone;
- identify and distinguish various sounds associated with the work place / patient care; see adequately to read computer screens, medical records, and written documents necessary to position;
discern temperature variances through touch.
Licensures and Certifications : Active California Registered Nurse (RN) required. Basic Life Support (BLS) certification from the American Heart Association (AHA) required.
Commission of Case Manager (CCM) certification preferred.
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