Case Manager - Transition Planning - Sharp Memorial - Per Diem - Days
Company: SHARP HEALTHCARE
Location: San Diego
Posted on: April 24, 2024
Job Description:
HoursShift Start Time:Shift End Time:Additional Shift
Information:Weekend Requirements:On-Call Required:NoFlat Hourly
Rate of Pay:$0.000 -What You Will DoThe RN CM 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.Required
Qualifications
- 3 Years Recent acute care nursing experience or case management
experience.
- California Registered Nurse (RN) - CA Board of Registered
Nursing -REQUIREDPreferred Qualifications
- Bachelor's Degree in Nursing
- Certified Case Manager (CCM) - Commission for Case Manager
Certification -PREFERREDEssential Functions
- Professional developmentThe RN CM 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.
- Core principlesThe RN CM 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 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 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
performs other duties as needed.
- Organizational relationshipsThe RN CM 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 will
work collaboratively with other members of the interdisciplinary
team to develop relationships and provide pre admission 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 will recommend and document patient
classification (status and level of care) for all admissions
utilizing established criterion sets.The RN CM has accountability
for maintaining compliance contractual and regulatory compliance
with medical groups as applicable and the hospital.The RN CM will
have excellent interpersonal skills demonstrated by the ability to
work effectively with individuals and or teams across
disciplines.
- Care coordination and discharge planningWithin 24 hours of
admission the RN CM will interview each patient/family for
anticipated needs post hospitalization. The plan and interventions
will be documented in the EMR (e.g., Cerner), and case management
software (e.g., Allscripts Care Management).The RN CM will develop
and document a plan for the day and plan for the stay with patient,
family, providers, and nursing staff.The RN CM will be responsible
for leading the daily care coordination (multidisciplinary) rounds,
update the plan, and facilitate necessary coordination of
services.The RN CM will document and initiate discharge plan
including early referrals and authorization for LTAC, SNF, Rehab,
homecare, DME and infusion services.The RN CM 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 will
follow standards for routine patient/family conference.The RN CM
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 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 will facilitate increased volume of cases
discharged early in the day to improve capacity management.The RN
CM will collect and document avoidable days information in
appropriate case management software, e.g., Allscripts Care
Management.The RN CM will participate in venues to reduce barriers
to discharge.The RN CM Collaborates with Clinical Resource
Coordinators (CRCs/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 provides timely
delivery of regulatory and mandated patient communications and
correspondence.The RN CM oversees preparation, delivery and
documentation of non-coverage letters.The RN CM identifies and
escalates potential quality variances to management and document
per guidelines.The RN CM interview all patients with an admission
within 30 days to determine what went wrong in the discharge.
He/she documents as appropriate in Cerner and Allscripts Care
Management and provides information to the department head as
indicated.
- Utilization review and utilization managementThe RN CM
will:Conduct initial review at POE or within 24 hours of admission
utilizing appropriate care guidelines software. Document findings
in CM software, e.g., Allscripts Care Management.Identify
anticipated LOS and document in Allscripts Care Management,
communicate to healthcare team.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 Allscripts Care
Management.Assure correct documentation is present for 2MN
benchmark and presumption.Assure Medicare Inpatient to observation
status changes follow Condition Code 44 requirements.Actively work
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 Care Management software such as
Allscripts.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
- PC, data management and analysis skills required, (experience
with InterQual, and or MCG and Allscripts Care Management an
Asset).
- Excellent interpersonal skills, as demonstrated by the ability
to work effectively with individuals and or teams, and across
disciplines.
- Excellent communication and negotiation skills as demonstrated
in oral and written forms.
- Ability to work in a collaborative partnership model with
Social Workers and other members of the interdisciplinary team,
both internal and external.
- Organizational and time management skills, as evidence by
capacity to prioritize multiple tasks.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.Certified Case Manager (CCM) - Commission for
Case Manager Certification; California Registered Nurse (RN) - CA
Board of Registered Nursing
Keywords: SHARP HEALTHCARE, La Mesa , Case Manager - Transition Planning - Sharp Memorial - Per Diem - Days, Executive , San Diego, California
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