The RN Case Manager is responsible for performing clinical assessment and reassessment of acute care Inpatients for the purpose of performing utilization review, resource management and safe discharge planning.
Prioritizes, plans, organizes, and implements timeliness of care.
Collaborates with the interdisciplinary healthcare team to promote and coordinate the delivery of safe and cost-effective patient care, transition of care and discharge planning.
Advocates for patient self-determination and choice.
Practices clinical competence in evaluations and planning with awareness and respect for patient and family diversity.
Monitors and coordinates resource utilization throughout the continuum of care and evaluates timeliness of services.
Performs admission, continued stay and discharge review utilizing medical staff-approved decision support criteria.

One year of case management experience or 1 year nursing leadership experience
Current Licensure as a Registered Nurse in the State of California
Computer/EMR Proficiency and Literacy
Knowledge of CMS, Medicare, Medi-Cal and Managed Care reimbursement
Familiarity of Joint Commission, CMS, CDPH requirements
Excellent written and verbal communication skills in English
Ability to establish and maintain effective working relationships across the organization
Ability to facilitate and lead interdisciplinary rounds
Bachelor of Science in Nursing (Preferred)
Certified Case Manager (CCM) (Preferred)
Familiarity with AllScripts Care Management (Preferred)
Proficiency with Milliman Care Guidelines or Interqual (Preferred)
Bilingual skills to communicate effectively with patients and families (Preferred)

Chronic Care Manager, Pop Health, Value Based Care

Key skills