RN Case Manager

Qualifications

The Case Manager is responsible for managing a continuum of care from admission through discharge for assigned patients. Partners with medical staff, utilizes scientific evidence for best practices, relevant data and compliance with the mission/philosophy, standards, goals and core values. Participates in the development of patient focused long/short term goals, implementing, evaluating and modifying the care plan.

Collects and reports utilization data and quality information, such as delays in service, possible avoidable days, provider preventable conditions, readmissions, and length of stays, etc. Assists in preparing UM/QI case issues, gathering requested records/responses. Consults with the nursing staff working directly with clients in the nursing care areas.

Maintains current knowledge of evidence based nursing care practices. Educates nursing staff about state and federal rules and regulations in preparation for accreditation. Evaluates and verifies employee performance through the review of completed work assignments and work techniques. Ensures delivery of quality care to patients, enhancement of business development, and continuous improvement of agency efficiency and fiscal success.

Provides instruction to hospitalized members and their families; and serves as liaison between the member, the physician, the hospital and the Plan. Case Manager completes appropriate, accurate and timely, documentation into EMR system every shift Requirements for Case Manager : Active CA Registered Nurse Acute clinical experience Experienced in case management, UR/UM Possesses knowledge of applicable regulatory standards and is able to perform audits based upon these standards Solid experience dealing with UR concepts Computer literate Excellent verbal and written communication skills