Case Management Nurse
Emergency Department Case ManagerDuration:
6 month contract- possible conversion to perm!Schedule:
4x10s Monday-Friday, Rotating WeekendsShifts Available:
Late Nights- 2:
30pm - 1:
00am (1 opening) Overnights- 8:
30pm - 7:
00am (2 openings)
Responsibilities:
Utilization Review - Perform timely comprehensive utilization reviews on patient medical records to determine the appropriate level of care, medical necessity, and adherence to Hospital guidelines.
Evaluate and analyze patient data, treatment plans, and progress notes to ensure compliance with established standards and guidelines.
Coordination of Care -- Collaborate with healthcare teams, including physicians, nurses, social workers, and other professionals, to ensure continuity and appropriateness of care.
Facilitate communication and coordination among healthcare providers, patients, and payers to optimize patient outcomes and minimize unnecessary healthcare services.
Manages each patient's transition through the system and transfers accountability to the appropriate person upon entry into another clinical service or discharge.
Discharge Planning - - Coordinates and facilitates timely implementation of discharge plans for assigned patients with complex needs in collaboration with other interdisciplinary team members; arranges follow-up care as appropriate.
Education/Consultation -- Acts as an educational resource and provides consultation to patients and their families, hospital medical personnel regarding the discharge planning process and applicable regulatory requirements; educates the staff on case management; and provides specific information related to case types.
Lead Work -- May lead the work of administrative/clinical support staff responsible for assisting with case management for an assigned patient caseload.
Other -- Participates in department program planning, goal setting, systems development, and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes, and reports on data for utilization, quality improvement, compliance, and other areas as assigned.
Patient Assessment / Plan of Care -- Functions as a resource to and collaborates with physicians, social workers, nurses, and other interdisciplinary team members to assess, plan, and coordinate patient care needs and/or performs patient assessment and develops a plan of care to assure consistent, timely, and appropriate care is provided in a patient-focused manner.
Quality Improvement -- Participates in quality improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection; participates in clinical process improvement teams within the department, service lines, and hospital.
Third-Party Reimbursement -- Collects, analyzes, reports and reviews patient information with third-party payors to assure reimbursement for patient services/procedures.
Communicates with review organizations / payers to provide requested clinical and psychosocial information to assure reimbursement.
MINMUM QUALIFICATIONSEducation QualificationsBachelor's Degree or higher in Nursing from an accredited academic institution.
Licenses and Certifications CA Registered Nurse (RN) ACM-RN certification within 2 years of hire Experience1
year of Case Management experience in an ER/ED setting or in a Level 1 or 2 Trauma CenterMUST have experience as a Case Manager- general nursing experience is NOT adequate for this specialized role KNOWLEDGE/SKILLS & ABILITIES Ability to collect and record data, evaluate data and statistics, and maintain effective reporting systems Ability to develop and perform patient assessment and plan of care Ability to monitor and assure the patient's access to the appropriate level of care; the right health care providers; and the correct setting and services to meet the patient's needs; promote coordination and continuity in patient health care Ability to provide age-appropriate assessments, interpretation of data, and delivery of interventions Ability to provide appropriate patient care and clinical information when patients are admitted, referred, transferred, or discharged Ability to remain knowledgeable regarding available treatments and services Ability to resolve conflicts and/or negotiate with others to achieve positive results; establish and maintain effective interpersonal relationships Ability to understand, interpret and apply complex federal and state hospital compliance laws, rules, regulations, and guidelines Ability to work effectively with individuals at all levels of the organization Knowledge of available patient services and treatment Knowledge of current theories, principles, practices, standards, emerging technologies, techniques and approaches in the nursing profession, and the health care system, and the responsibility and accountability for the outcome of practice Knowledge of evaluation and assessment techniques Knowledge of financial processes of various private and public funding sources for health care services/procedures Knowledge of hospital operations, organization, systems and procedures and laws and regulations pertaining to the operation of hospitals in California Knowledge of medical terminology and related levels of care and treatment Knowledge of the full continuum of care available to patients, interrelationships of the care components, and their effective integration Knowledge of the models of case management, including the principles and practices of discharge planning, utilization review, and quality assurance/improvement Knowledge of the variables that affect the processes and outcomes of patient health care Recommended Skills Administration Assessments Business Process Improvement Case Management Certified Nurse Practitioner Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
6 month contract- possible conversion to perm!Schedule:
4x10s Monday-Friday, Rotating WeekendsShifts Available:
Late Nights- 2:
30pm - 1:
00am (1 opening) Overnights- 8:
30pm - 7:
00am (2 openings)
Responsibilities:
Utilization Review - Perform timely comprehensive utilization reviews on patient medical records to determine the appropriate level of care, medical necessity, and adherence to Hospital guidelines.
Evaluate and analyze patient data, treatment plans, and progress notes to ensure compliance with established standards and guidelines.
Coordination of Care -- Collaborate with healthcare teams, including physicians, nurses, social workers, and other professionals, to ensure continuity and appropriateness of care.
Facilitate communication and coordination among healthcare providers, patients, and payers to optimize patient outcomes and minimize unnecessary healthcare services.
Manages each patient's transition through the system and transfers accountability to the appropriate person upon entry into another clinical service or discharge.
Discharge Planning - - Coordinates and facilitates timely implementation of discharge plans for assigned patients with complex needs in collaboration with other interdisciplinary team members; arranges follow-up care as appropriate.
Education/Consultation -- Acts as an educational resource and provides consultation to patients and their families, hospital medical personnel regarding the discharge planning process and applicable regulatory requirements; educates the staff on case management; and provides specific information related to case types.
Lead Work -- May lead the work of administrative/clinical support staff responsible for assisting with case management for an assigned patient caseload.
Other -- Participates in department program planning, goal setting, systems development, and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes, and reports on data for utilization, quality improvement, compliance, and other areas as assigned.
Patient Assessment / Plan of Care -- Functions as a resource to and collaborates with physicians, social workers, nurses, and other interdisciplinary team members to assess, plan, and coordinate patient care needs and/or performs patient assessment and develops a plan of care to assure consistent, timely, and appropriate care is provided in a patient-focused manner.
Quality Improvement -- Participates in quality improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection; participates in clinical process improvement teams within the department, service lines, and hospital.
Third-Party Reimbursement -- Collects, analyzes, reports and reviews patient information with third-party payors to assure reimbursement for patient services/procedures.
Communicates with review organizations / payers to provide requested clinical and psychosocial information to assure reimbursement.
MINMUM QUALIFICATIONSEducation QualificationsBachelor's Degree or higher in Nursing from an accredited academic institution.
Licenses and Certifications CA Registered Nurse (RN) ACM-RN certification within 2 years of hire Experience1
year of Case Management experience in an ER/ED setting or in a Level 1 or 2 Trauma CenterMUST have experience as a Case Manager- general nursing experience is NOT adequate for this specialized role KNOWLEDGE/SKILLS & ABILITIES Ability to collect and record data, evaluate data and statistics, and maintain effective reporting systems Ability to develop and perform patient assessment and plan of care Ability to monitor and assure the patient's access to the appropriate level of care; the right health care providers; and the correct setting and services to meet the patient's needs; promote coordination and continuity in patient health care Ability to provide age-appropriate assessments, interpretation of data, and delivery of interventions Ability to provide appropriate patient care and clinical information when patients are admitted, referred, transferred, or discharged Ability to remain knowledgeable regarding available treatments and services Ability to resolve conflicts and/or negotiate with others to achieve positive results; establish and maintain effective interpersonal relationships Ability to understand, interpret and apply complex federal and state hospital compliance laws, rules, regulations, and guidelines Ability to work effectively with individuals at all levels of the organization Knowledge of available patient services and treatment Knowledge of current theories, principles, practices, standards, emerging technologies, techniques and approaches in the nursing profession, and the health care system, and the responsibility and accountability for the outcome of practice Knowledge of evaluation and assessment techniques Knowledge of financial processes of various private and public funding sources for health care services/procedures Knowledge of hospital operations, organization, systems and procedures and laws and regulations pertaining to the operation of hospitals in California Knowledge of medical terminology and related levels of care and treatment Knowledge of the full continuum of care available to patients, interrelationships of the care components, and their effective integration Knowledge of the models of case management, including the principles and practices of discharge planning, utilization review, and quality assurance/improvement Knowledge of the variables that affect the processes and outcomes of patient health care Recommended Skills Administration Assessments Business Process Improvement Case Management Certified Nurse Practitioner Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
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