Case Manager RN

  • Organization

  • Santa Rosa Medical Center Santa Rosa Medical Center

  • Apply Now

  • Full Time

Job Description

Coordinates the overall interdisciplinary plan of care for a patient, from admission to discharge. Acts as a liaison between patient/family and healthcare personnel to ensure necessary care is provided promptly and effectively. Relies on experience and judgment to plan and accomplish goals. Performs a variety of tasks. A certain degree of creativity and latitude is required. Typically reports to a head of a department/unit. Associates degree required, bachelors degree prefer. Must be a registered nurse with at least 2 years of clinical experience. Familiar with standard concepts, practices, and procedures within a particular field.

  • Promote the mission, vision, and values of the organization
  • Facilitate team meetings that foster interdepartmental collaboration with the patient and their family as deemed necessary, this includes multidisciplinary meetings and Utilization Review/Case Management meetings. Provides input in such meetings 6regarding utilization management and discharge planning.
  • Responsible for evaluating and screening potential admissions to the facility when appropriate.
  • Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage.
  • Communicate daily with admissions personnel regarding admissions and discharges to various units.
  • Initiate ongoing communication with the resident and resident’s family to assess discharge needs.
  • Communicate with physicians to ascertain their plans for a timely discharge.
  • Document discharge planning as an ongoing review.
  • Knowledgeable of resident’s financial status, diagnosis and discharge needs.
  • Responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
  • Cooperate with insurance companies, based on information received.
  • Manage and collaborate with the healthcare team on Swing Bed placement and complete MDS documentation as necessary.
  • Ensures that a quality of care is maintained or surpassed by collecting quality indicators and variance data and reporting the data to the appropriate department; reports and identifies data that indicates potential areas for improvement of care and services provided within the system.
  • Assist as needed with obtaining referrals, prior authorization for Home Health Care, DME, SNF, acute rehab and appointments.
  • Educates physicians and staff regarding appropriate level of care/utilization issues.
  • Develop and implement methods, policies and procedures to improve the departments’ efficiency and overall effectiveness.
  • Oversight and evaluation of the discharge planner/ utilization review nurse.
  • Perform and oversee needs analysis and planning. Work with executive leadership to ensure targets are met for the annual operating plan/financial management.
  •   Perform other duties as assigned.
Apply Now