RN - Case Manager - AS Utilization Management - Walnut Creek - Full Time - 8 Hour - Days

John Muir Health

$181K — $246K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's Degree from an accredited School of Nursing is required.
  • Minimum 3 years of Nursing experience in Medical/Surgical or Critical Care is preferred.
  • 2 years of experience in Care Coordination or equivalent work experience is preferred.
  • Active RN licensure from the California Board of Nursing is required.
  • BLS certification from the American Heart Association is required; ACM or CCM certification is strongly preferred.

Responsibilities

  • Advocate for patients to ensure appropriate resource utilization during hospitalization.
  • Assess, plan, implement, monitor, and evaluate patient care needs in collaboration with the interdisciplinary team.
  • Coordinate transitions of care from inpatient to community settings.
  • Provide education to patients and families about care management outside the hospital.
  • Ensure compliance with guidelines and regulations pertinent to patient management levels.

Benefits

  • Flexible scheduling with a focus on work-life balance.
  • Access to professional development and continuing education opportunities.
  • Supportive interdisciplinary team environment.
  • Engagement with diverse patient populations and care challenges.
  • Opportunities for leadership and mentorship in a clinical setting.
Full Job Description
Job Description:
Job Profile Summary
The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient's health care needs through hospitalization and transition back to the community and does this in coordination with the interdisciplinary health team.

The RN Case Manager is expected to function within the full scope of the nursing practice with specialized focus on care coordination, compliance, transition management, education, and utilization management. The RN CM, SW and care transitions team work in a collaborative approach, along with the individual patient and or their caregiver, to remove barriers for the safe transition of the patient.

Education:
  • Associate's Degree Accredited School of Nursing or
  • Degree/Diploma Obtained - Accredited School of Nursing Required


Experience:
  • 2 years Case Management or Equivalent Work Experience Preferred
  • 3 years Nursing - Medical/Surgical Preferred or
  • 3 years Nursing - Critical Care Preferred


Certifications/Licensures:
  • RN Registered Nursing - California Board of Nursing Required
  • BLS Basic Life Support - American Heart Association Required
  • ACM Accredited Case Manager - ACMA American Case Management Association or
  • CCM Certified Case Manager - CCMC Commission for Case Manager Certification Strongly Preferred


Skills:
  • Strong written and verbal communication skills. Effectively motivates teams.
  • Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning.
  • Working knowledge of common diagnoses and procedures and the impact this will have to patients/families and their ability to manage their care outside of the hospital. Specialized knowledge may be required for certain areas of practice.
  • Knowledge of individual and family development over the life span, and the influences of cultural and spiritual values in health care.
  • General knowledge of commercial coverage plans and usually covered benefits. Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements such as ACOs, DRGs, Full Risk, etc.
  • Strong understanding of the criteria, rules and regulations around Inpatient, Observation and Outpatient levels of patient management. Strong knowledge of geriatrics and the impact to health and function in the aged as well as a working knowledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc. Clear understanding of the role of the inpatient Social Worker and Palliative Care Resources.
  • Ability to plan, organize, manage time and prioritize work in collaboration with others.
  • Ability to work independently and as a part of a multidisciplinary team.
  • Effective problem solving and conflict resolution skills.
  • Ability to work respectfully and creatively with clients of diverse functional abilities, social, economic, and cultural backgrounds to support both client autonomy and client safety.
  • Leadership skills to delegate and provide direction/guidance to staff and hold others accountable.
  • Able to learn and work in a variety of computer programs, including EPIC, InterQual, Allscripts, and Microsoft Outlook.




Days worked per week: 5

Hours worked per day: 8

work schedule:

Sunday to Wednesday (week 1)

Sunday-Thursday (week2)

Work Shift:
08.0 - 08:00 - 16:30 No Waive (United States of America)

Pay Range:
$87.06 - $118.62

Hourly

Offer amounts are based on demonstrated/relevant experience and/or licensure.

Pay will be adjusted to the local market if hired outside of the Bay Area.

Note: Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting. The work shift will contain the word 'exempt' on it.

Scheduled Weekly Hours:
36

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