Job Summary: The Case Manager serves as a key member of the patient care delivery team in a Magnet Recognized large tertiary academic medical center with level one trauma designation, ST-Elevation Myocardial Infarction (STEMI) receiving center designation, and Comprehensive Stroke Center and Chest Pain Center accreditation. Works efficiently in a fast-paced environment and utilizes clinical expertise, discretion, and independent judgement in performing the nursing process (assessment, care planning, intervention, evaluation) within a patient-centered care professional practice model (Duffy's Quality-Caring Model) as it relates to case management functions. Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria (medical necessity) are met for level of care provided and is documented from admission through discharge. Practices in a collaborative health care environment to oversee implementation of a well-thought-out interdisciplinary plan of care with an individualized discharge plan that is comprehensive and best meets the continuing healthcare needs of the patient. Reevaluates the plan of care and ensures continued appropriateness based on the patient's changing needs and condition. Functions within the expectations of a professional nurse and meets nursing excellence standards to achieve and maintain Magnet Recognition as outlined by the American Nurses Credentialing Center. Represents nursing as an empowered profession and readily embraces new knowledge, innovations, and improvements. Exhibits positivity and serves as an instrumental change agent and expertly minimizes resistance to change in the workforce, clinical practice, and operational setting. Engages in opportunities to directly and/or indirectly influence decision-making for bedside clinical practice by participating in professional governance councils, committees, taskforces, and staff meetings. Performs other duties as needed.
Education and Experience: Bachelor's Degree in nursing required. Minimum of one year of patient care experience required. Minimum of two years of Hospital Case Management or Utilization Management experience preferred.
Knowledge and Skills: Basic knowledge of case and utilization management practice and methodologies and state and federal healthcare regulations and accreditation required. Able to: speak, read, and write legibly in English (and Spanish preferred) with professional quality; use computer, printer, and software programs necessary to the position, e.g., Microsoft Office Suite, Outlook, electronic medical record, electronic event reporting program. Relate and communicate positively, effectively and exhibit professional behavior at all times; work calmly and respond courteously when under pressure; be assertive and consistent in following policies; teach, and collaborate; accept direction; think critically; work independently with minimal supervision; perform basic math and statistical functions; manage multiple assignments effectively; organize and prioritize workload; problem solve; recall information with accuracy; pay close attention to detail; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, medical records, and written documents necessary to the position.
Licensures and Certifications: Active California Registered Nurse (RN) license required. Basic Life Support (BLS) certification issued by the American Heart Association required. Nationally recognized certification in Utilization Management or Case Management preferred.
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