RN Case Manager I- Sharp Memorial Hospital -FT - Days
Company: SHARP HEALTHCARE
Location: Orange
Posted on: April 24, 2024
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Job Description:
HoursShift Start Time:9 AMShift End Time:5:30 PMAdditional Shift
Information:Weekend Requirements:As NeededOn-Call Required:NoHourly
Pay Range (Minimum - Midpoint - Maximum):$54.400 - $67.470 -
$80.540 -The stated pay scale reflects the range as defined by the
collective bargaining agreement between Sharp HealthCare and Sharp
Professional Nurses Network, United Nurses Associations of
California/Union of Health Care Professionals, NUHHCE, AFSME,
AFL-CIO. - Placement within the range is based on years of RN
experience.
What You Will Do
The RN CM I assesses, develops, implements, coordinates and
monitors a comprehensive plan of care for each patient/family in
collaboration with the physician, social worker and all members of
the interdisciplinary team in the inpatient and emergency
department patient care areas. This position requires the ability
to combine clinical/quality considerations with
regulatory/financial/utilization review demands to assure patients
are receiving care in the appropriate setting and level of care.
The position creates a balance between individual clinical needs
with the efficient and cost-effective utilization of resources
while promoting quality outcomes. This position requires critical
thinking and advanced problem-solving and time management
skills.
Required Qualifications
Preferred Qualifications
Essential Functions
The RN CM I will:
Actively participates in the performance-planning, competency and
individual development planning process.
Maintain current knowledge of case management, utilization
management, and discharge planning, as specified by Sharp, federal,
state, and private insurance guidelines.
The RN CM I will make timely referrals to ensure that the patient
is receiving the appropriate care, in the appropriate setting and
using the appropriate utilization standards as set by community and
professional standard as adopted by the medical staff.
The RN CM I will assure that the patients from all age groups
proceed efficiently through the course of hospitalization and
beyond through the continuum of care.
The RN CM I will 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,
collaborate and accept direction.
The RN CM I performs other duties as needed.
The RN CM I will work closely with the healthcare team in reaching
unit, facility, and system/network organization goals including
reductions in length of stay, decreasing denials, improvement of
care transitions, and reduction in avoidable readmissions, improved
patient experience, and other quality initiatives.
In the emergency departments, the RN CM I will work collaboratively
with other members of the interdisciplinary team to develop
relationships and provide preadmission status recommendations for
admissions as well as implement a comprehensive, integrated
discharge plan from the emergency department(ED) for patients who
are being discharged to a lower level of care.
The RN CM I will recommend and document patient classification
(status and level of care) for all admissions utilizing established
criterion sets.
The RN CM I has accountability for maintaining compliance
contractual and regulatory compliance with medical groups as
applicable and the hospital.
The RN CM I will have excellent interpersonal skills demonstrated
by the ability to work effectively with individuals and or teams
across disciplines.
Within 24 hours of admission the RN CM I will interview/assess each
patient/family for anticipated needs post hospitalization.
The RN CM I will ensure patient choice is obtained and documented
in accordance with all state and federal regulatory
requirements.
The plan and interventions will be documented in the electronic
medical record (EMR), and case management software.
The RN CM I will develop and document a plan for the day and plan
for the stay with patient, family, providers, and nursing
staff.
The RN CM I will be responsible for leading the daily care
coordination (multidisciplinary) rounds, update the plan, and
facilitate necessary coordination of services.
The RN CM I will document and initiate discharge plan including
early referrals and authorization for LTAC, SNF, Rehab, homecare,
DME and infusion services.
The RN CM I will prepare patient/family for discharge. Document
expected discharge date per protocol and arrange discharge pick up
appointment with family or significant other.
In collaboration with SW partner, the RN CM I will follow standards
for routine patient/family conference.
The RN CM I will ensure effective and safe patient handovers to
next level of care; work closely with ambulatory care manager (ACM)
at the system level, in clinics, with SCMG and other complex care
Case Managers as appropriate, and homecare and sub-acute
liaisons.
The RN CM I will support the nursing Model of Care by working
closely with nursing managers and staff to achieve Patient and
Family Centered Care goals: respect and dignity, information
sharing, participation and collaboration.
The RN CM I will facilitate increased volume of cases discharged
early in the day to improve capacity management.
The RN CM I will collect and document avoidable day's information
in appropriate care management software.
The RN CM I will participate in venues to reduce barriers to
discharge.
The RN CM I Collaborates with Clinical Resource Coordinators
(CRC's/clinical assistants) to assure appropriate referrals for
care and services are directed to appropriate network providers,
and obtains prior authorization for in network and out of network
services as appropriate.
The RN CM I provides timely delivery of regulatory and mandated
patient communications and correspondence.
The RN CM I oversees preparation, delivery and documentation of
non-coverage letters.
The RN CM I identifies and escalates potential quality variances to
management and document per guidelines.
The RN CM I interviews all patients with an admission within 30
days to determine what went wrong in the discharge.
He/she documents as appropriate in the electronic medical record
and provides information to the department head as
indicated.
The RN CM I will:
Conduct initial review at POE or within 24 hours of admission
utilizing appropriate evidenced based care guidelines software.
Document findings in ICM software (EMR).
Identify anticipated LOS and document as per departmental
process.
Conduct daily concurrent reviews per protocol/policy and payer
request.
Utilize appropriate care guideline software to identify the correct
patient status and level of care.
Work with attending provider to assure correct status, if status
and order does not match; works with provider to resolve conflict
and document interventions in the EMR.
Assure correct documentation is present for 2MN benchmark and
presumption.
Assure Medicare Inpatient to observation status changes follow
Condition Code 44 requirements.
Actively works observation patient list assuring transitions to
next level of Care.
Communicates as indicated with third party payers to obtain
necessary authorization for reimbursement of services. Obtain
approved days/LOS from provider and communicates this to the care
team.
Refer defined cases for medical secondary review and share findings
with providers.
Provide advice to Revenue Cycle/HIM regarding RAC decision to
appeal, denials, input into appeals, share findings with
providers.
Review all cases with readmission within 30 days; report findings
in the EMR and in accordance with the departmental policy.
Identify opportunities for cost reduction and participate in
appropriate utilization management venues.
Escalate and refers cases for consultation with Physician Advisor
or Medical Director as appropriate.
Oversee preparation, delivery and documentation of non-coverage
letters.
Knowledge, Skills, and Abilities
Sharp HealthCare is an equal opportunity/affirmative action
employer. All qualified applicants will receive consideration for
employment without regard to race, religion, color, national
origin, gender, gender identity, sexual orientation, age, status as
a protected veteran, among other things, or status as a qualified
individual with disability or any other protected class
California Registered Nurse (RN) - CA Board of Registered Nursing;
Master's Degree; Bachelor's Degree in Nursing; Accredited Case
Manager (ACM) - American Case Management Association (ACMA);
Certified Case Manager (CCM) - Commission for Case Manager
Certification
Keywords: SHARP HEALTHCARE, Newport Beach , RN Case Manager I- Sharp Memorial Hospital -FT - Days, Executive , Orange, California
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