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RN Case Manager - Full Time Days

Job ID MPHS-1824568 Date Posted 01/07/2019 Location Burlingame, California
Position Overview:
The RN Case Manager is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience.  The RN Case Manager works in collaboration with the Physician, Medical Social Worker and bedside RN to assure the timely movement of patients to the appropriate level of care to prevent unnecessary admissions or readmissions.   Oversees the management of acute patient populations across the care continuum with the primary focus to provide coordinated, timely and integrated care. The RN Case Manager reports to either the Supervisor or Manager or Director of Care Coordination in each facility. The RN Case Manager has frequent contact with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources.
The Case Management Department at MPHS embraces the Scope of Services adopted by the American Case Management Association which states: “Case Management in Hospital and Health Care Systems is a collaborative practice model including patients, nurses, social workers, physicians and other practitioners, caregivers and the community.  The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination.  The goals of Case Management include the achievement of optimal health access to care and appropriate utilization of resources, balanced with the patient’s right to self-determination.”


Qualifications:

Education/Certification/Licensure:

  • BS in one of following: Nursing or Health Administration is required.
  • National Certification in Case Management (ACM, ANA, RN-BC Case Management) within 24 months of hire required.
  • CA RN license required.
  • MS in Nursing, Case management or related field desired.

Experience:

  • Minimum of three (3) years in acute medical/surgical/ED or critical care nursing area required.  Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED or critical care area may be considered for employment at director's discretion.
  • Previous Case Management experience preferred.
  • Experience utilizing electronic InteQrual or other standardized criteria strongly preferred.
  • Previous leadership abilities preferred.

Knowledge:

  • Excellent interpersonal communication and negotiation skills.
  • A broad knowledge base of health care delivery and case management within a managed care environment.
  • Comprehensive knowledge of Utilization Review, levels of care and observation status.
  • Some awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS preferred.
  • Post-acute levels of care such as Home Health, Hospice, AIM and Palliative Care.  SNF, LTAC, B&C, Sub-acute, Acute rehab.
  • General knowledge of coding and DRG assignment process preferred.

Skills:

  • Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.
  • Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
  • Demonstrates commitment to service excellence in all patient, family and employee interactions and in performing all job responsibilities. 
  • Functions in a manner to promote quality patient care and assure a positive patient experience.
  • Excellent verbal and written communication skills.
  • Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
  • Intermediate computer skills.
  • Ability to promote teamwork and to effectively function in teams.
  • Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience. 


Organization: Mills-Peninsula Health Services
Employee Status: Regular
Employee Referral Bonus: No
Benefits: Yes
Position Status: Non-Exempt
Union: No
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Varied Days
Weekend Requirements: Rotating
Schedule: Full Time
Hrs Per 2wk Pay Period: 80

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity, or expression, ancestry, national origin, age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy, childbirth or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.