RN Case Manager PD II-BU / Sharp Grossmont Hospital / Per Diem / Variable Shifts
Company: SHARP HEALTHCARE
Location: La Mesa
Posted on: May 12, 2022
What You Will Do
The 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.
3 Years Recent acute care nursing experience or case management
California Registered Nurse (RN) - CA Board of Registered Nursing
Associate's Degree in Nursing
Certified Case Manager (CCM) - Commission for Case Manager
The 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.
The 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.
The 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
The RN CM has accountability for maintaining compliance contractual
and regulatory compliance with medical groups as applicable and the
The RN CM will have excellent interpersonal skills demonstrated by
the ability to work effectively with individuals and or teams
Care coordination and discharge planning
Within 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
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
The RN CM will participate in venues to reduce barriers to
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
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 management
The 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
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
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
Refer defined cases for medical secondary review and share findings
Provide advice to Revenue Cycle/HIM regarding RAC decision to
appeal, denials, input into appeals, share findings with
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
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
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
California Registered Nurse (RN) - CA Board of Registered Nursing;
Certified Case Manager (CCM) - Commission for Case Manager
Certification; Associate's Degree in Nursing
Keywords: SHARP HEALTHCARE, La Mesa , RN Case Manager PD II-BU / Sharp Grossmont Hospital / Per Diem / Variable Shifts, Hospitality & Tourism , La Mesa, California
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