RN Case Manager II, Care Coordination, Per Diem, Days
Marin General Hospital, California, MO, United States
**ABOUT MARINHEALTH**MarinHealth is already realizing the benefits of impressive growth and has consistently earned high praise and accolades, including being Named One of the Top 250 Hospitals Nationwide by Healthgrades, receiving a 5-star Ranking for Overall Hospital Quality from the Centers for Medicare and Medicaid Services, and being named the Best Hospital in San Francisco/Marin by Bay Area Parent, among others.**Company:**Marin General Hospital dba MarinHealth Medical Center**Compensation Range:**$66.03 - $99.04**Work Shift:**10 Hour (days) (United States of America)**Scheduled Weekly Hours:**0**Job Description Summary:**The RN Case Manager, in collaboration with members of the healthcare team, leads the development and implementation of the interdisciplinary plan of care for patients, determining the appropriate level of care, supervising the provision of the discharge plan of care, and ensuring the effective quality and cost-efficient outcomes by performing concurrent and retrospective case review. This position functions as the key linkage between the physician, staff, and hospital leadership in the day-to-day management of appropriate and efficient patient care and functions as an advisor to the physician with accountability to escalate cases to the Medical Director (as necessary) to ensure the provision of appropriate and effective patient care.**Job Requirements, Prerequisites and Essential Functions:****Job Specifications:****Education:*** Bachelor of Science degree in Nursing preferred.**Experience:*** Three (3) or more years of experience in an acute patient care setting preferably in medical/surgical or critical care.* Substantial recent experience in utilization review and/or discharge planning in an acute care setting is strongly preferred.* Broad clinical background strongly preferred.* Experience demonstrating effective functional supervision and leadership skills preferred.**License and Certifications:*** Registered Nurse (RN) required at hire.* Basic Life Support (BLS) required at hire.* Integrative Agitation Management (IAMTAC) required within 30 days of hire.**Prerequisite Skills:*** Must have the ability to read, write, and follow English verbal and written instructions, and have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, positive personal influence and negotiation skills.* Leadership skills to delegate, functionally supervise, provide direction/guidance to staff and hold others accountable are required.* Must have the ability to work independently with a minimum of direction, anticipate and organize work flow, prioritize and follow through on responsibilities.* Must have strong clinical assessment and critical thinking skills necessary to provide utilization review/discharge planning services appropriate to patients with complex medical, emotional and social needs.* Strong attention to detail and accuracy is required.* Must have the ability to work in a high volume case load environment and deal effectively with rapidly changing priorities.* Demonstrated ability to work constructively with a broad spectrum of health care professionals is required.* Must be assertive and creative in problem solving, system planning and management.* Basic computer skills are required including use of Electronic Health Record.* Must be effective both as a team member and leader.**Primary Customer Served (Age Specific Criteria):*** Infants: Birth up to 1 year* Toddlers: 1 up to 3 years* Preschool Children: 3 up to 6 years* School Age Children: 6 up to 12 years* Adolescents: 12 up to 18 years* X Early Adults: 18 up to 45 years* X Middle Adults: 45 up to 61 years* X Late Adults: 61 up to 80 years* X Late, Late Adults: 80 years and upEmployees in this position must be able to demonstrate the knowledge and skills necessary to provide care and/or service based on the physical, psycho/social, educational, safety, and related criteria appropriate to the age of the patients served in his/her assigned service area.
**Patient Privacy (HIPAA Compliance):**
Employees in this position have access to protected health information. The protected health information a person in this position can access includes demographics, date of service, insurance/billing, medical record summary information, and all other information that may be contained in patient records. This position requires patient health information to perform the functions outlined as part of this position description.**Duties And Responsibilities:****Essential (Not Modifiable)****Care Coordination*** Works with the healthcare team to ensure the plan of care is expedited and barriers to efficient throughput are identified and corrected.* Creates a plan of care that outlines the key interventions and outcomes to be achieved each day of the inpatient stay.* Actively leads multidisciplinary case conferences in developing comprehensive, cost- effective case management plans that span the continuum.* Makes independent assessments and recommendations regarding course of action in complex situations and recommendations regarding, such as multi-system or special needs.* Identifies and refers quality and risk management concerns to appropriate level for corrective action plans and trending.* Proactively solicits physician’s orders for services.**Utilization and Resource Management*** Identifies target Length of Stay (LOS) by assigning a working DRG in MIDAS within 24 hours of admission.* Completes an admission review using standardized criteria within 24 hours of admission and documents review outcome.* Escalates to the Medical Director when criteria is not met and attending physician disagrees with findings.* Completes a continued-stay review according to policy to assure patient is at the appropriate level of care.* Monitors the length of stay in comparison with MS-DRG/GMLOS for all patients.* Completes concurrent review for specified health plans and includes medical necessity documentation to avoid payor denials.* Ensures that the patient is transitioned to the next level of care as quickly as possible once the patient no longer meets clinical criteria for the current level of care.* Works with physicians and CDI to ensure that clinical information available in the medical record is accurate and reflects the care rendered to the patient.* Collaborates with physicians to determine appropriate levels of care for post hospital care, use of hospital resources, and available community resources.* In a timely manner, communicates pertinent information to third-party payers and managed care organization to obtain authorization for care and prevent denials.* Reviews, processes, and issues denials to client/responsible party following regulatory guidelines and facility protocols. Informs client/responsible party of right of appeal and the appeal process. Collects data for the appeals process.* Identifies avoidable days, intervenes to correct delays, and enters outcomes in MIDAS in a timely manner according to policy and procedure.* Uses personal judgment within broad guidelines to initiate review of inappropriate utilization by physicians and follows-through to resolution (e.g., attending, department chair, utilization management medical director).**Discharge Planning/Initial Assessment/Development/Evaluation*** Completes an initial assessment within 24 hours of admission and documents findings in the electronic health record.* Reviews initial hospital admission and gathers additional medical, psychosocial and financial data from needs assessment, client/family, physicians, and other health care providers. Determines risk level and identifies client’s service needs.* Formulates a discharge plan after completing a face-to-face interview and discusses available/appropriate care options and obtaining input from the patient/family
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**Patient Privacy (HIPAA Compliance):**
Employees in this position have access to protected health information. The protected health information a person in this position can access includes demographics, date of service, insurance/billing, medical record summary information, and all other information that may be contained in patient records. This position requires patient health information to perform the functions outlined as part of this position description.**Duties And Responsibilities:****Essential (Not Modifiable)****Care Coordination*** Works with the healthcare team to ensure the plan of care is expedited and barriers to efficient throughput are identified and corrected.* Creates a plan of care that outlines the key interventions and outcomes to be achieved each day of the inpatient stay.* Actively leads multidisciplinary case conferences in developing comprehensive, cost- effective case management plans that span the continuum.* Makes independent assessments and recommendations regarding course of action in complex situations and recommendations regarding, such as multi-system or special needs.* Identifies and refers quality and risk management concerns to appropriate level for corrective action plans and trending.* Proactively solicits physician’s orders for services.**Utilization and Resource Management*** Identifies target Length of Stay (LOS) by assigning a working DRG in MIDAS within 24 hours of admission.* Completes an admission review using standardized criteria within 24 hours of admission and documents review outcome.* Escalates to the Medical Director when criteria is not met and attending physician disagrees with findings.* Completes a continued-stay review according to policy to assure patient is at the appropriate level of care.* Monitors the length of stay in comparison with MS-DRG/GMLOS for all patients.* Completes concurrent review for specified health plans and includes medical necessity documentation to avoid payor denials.* Ensures that the patient is transitioned to the next level of care as quickly as possible once the patient no longer meets clinical criteria for the current level of care.* Works with physicians and CDI to ensure that clinical information available in the medical record is accurate and reflects the care rendered to the patient.* Collaborates with physicians to determine appropriate levels of care for post hospital care, use of hospital resources, and available community resources.* In a timely manner, communicates pertinent information to third-party payers and managed care organization to obtain authorization for care and prevent denials.* Reviews, processes, and issues denials to client/responsible party following regulatory guidelines and facility protocols. Informs client/responsible party of right of appeal and the appeal process. Collects data for the appeals process.* Identifies avoidable days, intervenes to correct delays, and enters outcomes in MIDAS in a timely manner according to policy and procedure.* Uses personal judgment within broad guidelines to initiate review of inappropriate utilization by physicians and follows-through to resolution (e.g., attending, department chair, utilization management medical director).**Discharge Planning/Initial Assessment/Development/Evaluation*** Completes an initial assessment within 24 hours of admission and documents findings in the electronic health record.* Reviews initial hospital admission and gathers additional medical, psychosocial and financial data from needs assessment, client/family, physicians, and other health care providers. Determines risk level and identifies client’s service needs.* Formulates a discharge plan after completing a face-to-face interview and discusses available/appropriate care options and obtaining input from the patient/family
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