RN - Case Manager - AS Utilization Management

About This Role

Serve as a patient advocate, managing the utilization of resources for inpatient care. Coordinate with an interdisciplinary health team to assess, plan, implement, monitor, evaluate, and coordinate patient care from hospitalization through community transition.

Responsibilities

• Advocate for appropriate utilization of patient resources
• Apply the process of assessment, planning, implementation, monitoring, evaluation, and coordination of care
• Meet patient’s health care needs through hospitalization and transition back to the community
• Coordinate care with the interdisciplinary health team
• Function within the full scope of nursing practice with specialized focus on care coordination, compliance, transition management, education, and utilization management

Requirements

• Bachelor's Degree Accredited School of Nursing
• RN Registered Nursing - California Board of Nursing
• BLS Basic Life Support - American Heart Association
• Strong written and verbal communication skills
• Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources
• Working knowledge of common diagnoses and procedures
• Knowledge of individual and family development over the life span, and cultural/spiritual values in health care
• General knowledge of commercial coverage plans and covered benefits
• Strong understanding of various reimbursement models (ACOs, DRGs, Full Risk)
• Strong understanding of criteria, rules, and regulations for Inpatient, Observation, and Outpatient levels of patient management
• Strong knowledge of geriatrics, chronic/progressive disease states (CHF, COPD, Diabetes, End Stage Renal Disease)
• Clear understanding of the role of inpatient Social Worker and Palliative Care Resources
• Ability to plan, organize, manage time and prioritize work
• Ability to work independently and as part of a multidisciplinary team
• Effective problem solving and conflict resolution skills
• Ability to work respectfully and creatively with diverse clients
• Leadership skills to delegate and provide direction/guidance to staff and hold others accountable
• Able to learn and work in EPIC, Allscripts, InterQual, and Microsoft Outlook

Qualifications

• Bachelor's Degree Accredited School of Nursing
• 3 years of Nursing (Medical/Surgical or Critical Care) preferred, or 2 years Care Coordination - Case Management preferred or equivalent

Nice to Have

• 3 years Nursing - Medical/Surgical
• 3 years Nursing - Critical Care
• 2 years Care Coordination - Case Management

Skills

* Required skills

Certifications