Case Manager, RN

Overview

Under the general supervision of the case management Director acts as a patient advocate / case manager to hospital clients.

An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes.

Looks for opportunities to reduce cost while ensuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay.

Provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.

Works collaboratively with interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care.

Responsibilities

Under the general supervision of the Case Management Director, the RN Case Manager, Emergency Department acts as a patient advocate / case manager to hospital clients.

An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes.

Looks for opportunities to reduce cost while ensuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay.

Provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.

Works collaboratively with interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care.

• The RN Case Manager, Emergency Department (ED) is responsible for establishing, coordinating and maintaining the process to increase patient care while facilitating interdisciplinary care across the continuum for ED.
• The RN Case Manager, ED collaborates with the patient / family, multidisciplinary team, and physicians to ensure the patient's progress and level of care is appropriately determined for the emergency episode of care and for the inpatient encounter to ensure that care is performed and facilitated in an efficient and cost-effective manner.
• This RN Case Manager, ED has well developed knowledge and skills in patient status determination, in the assessment and care management of patients and families within ED, inpatient and outpatient settings.
• The scope of practice includes patient / family assessment and management, resource management, identifying patients appropriate for inpatient admission, observation, or outpatient status, care facilitation, discharge planning with referral to all levels of care, and other related duties specific to the defined patient population.
• This RN Case Manager, ED collaborates with other case managers, social work staff, admissions, and other physician and administrative leadership staff within the ED.
• The RN Case Manager, ED uses knowledge of clinical care processes to participate with other clinical staff and physicians in the development of clinical practice guidelines and physician orders for the purpose of improving quality of care.

Qualifications

Two years of Case Management experience in an acute care environment preferred. Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking.

Knowledge of healthcare financing, community and organizational resources, patient care processes, and data analysis. Knowledge of utilization management as it relates to third-party payers.

Experience with managed care preferred. Excellent verbal and written communication skills required. Demonstrates flexibility via an ability to adapt to changing priorities and regulations.

BSN or MSW preferred. Current California RN and BLS certification required.