Care Manager II, Acute, Registered Nurse
Company: Sutter Health
Location: Delhi
Posted on: May 28, 2023
Job Description:
Organization:
SMCS-Valley Administration
Position Overview:
Responsible for Care Coordination and Care Transitions Planning
throughout the acute care patient experience. This position works
in collaboration with the Physician, Utilization Manager, Medical
Social Worker and bedside RN to assure the timely progression and
transition of patients to the appropriate level of care to prevent
unnecessary admissions or readmissions. The Care Management process
encompasses communication and facilitates care across the continuum
through effective resource coordination. The goals of this role are
to include the achievement of optimal health, access to care, and
appropriate utilization of resources balanced with the patients'
self -determination while coordinating in a timely and integrated
fashion. He/She collaborates 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. If assigned to the Emergency Department,
the Care Management process is to address complex clinical and
social situations efficiently in order to avoid unnecessary
admissions.
Job Description:
Patient Initial and Continued Assessment.
- Reviews initial physician admission care plan. Gathers
additional medical, psychosocial, and financial information from
the patient/family interview, medical record assessment,
physicians, and other health care providers. Determines moderate or
high-risk level for readmission. Conducts a screening for ancillary
supportive services, including but not limited to Palliative Care
Services' needs.
- Functionally supervises and actively leads the health care team
in developing comprehensive cost-effective care coordination plans
that meet the clinical needs of our patients.
- Identifies and refers quality and risk management concerns to
appropriate level for patient safety reporting and trending.
- Directs and oversees the Case Management Assistants to
determine preferences for post-acute care services. Utilization
Management:
- Reviews medical record to ensure patient continues to meet
level of care (LOC) requirements and that chart documentation
supports LOC determination and assignment.
- Works with Attending Physicians to confirm necessary
documentation to support level of care (LOC).
- Expedites transition planning for patients who no longer
require acute level of care.
- Monitors length of stay (LOS) and outliers requiring additional
resources and/or focus.
- Collaborates with financial counselor for delivery of inpatient
stay denials.
- Assures delivery of Medicare Important Message within 48 hours
of discharge/transition and no less than 4 hours of actual
discharge/transition.
- Actively participates in patient rounds following the standard
work as developed and collaborates with interdisciplinary team to
assure timely transition.
- Follows policies and procedures for Physician Advisor
referrals.
- Utilizes appropriate escalation process when discussing level
of care (LOC) requirements with providers.
- Consistently documents in the EHR and other electronic
software.
- Maintains current knowledge of CMS and Joint Commission
Transitions of Care requirements, Conditions of Participation
(COPs), and other regulatory requirements.
- Effectively follows Observation patients, re-evaluates and
collaborates with attending physician for admission or transition
to appropriate level of care for the patient. Care Coordination/
Care Transitions
- Formulates a transition plan after reviewing
available/appropriate care options and obtaining input, and
collaborating with the patient/family and physician, health care
team, payers, and community-based support services.
- Performs, documents, and communicates assessment findings to
health care team.
- Screens 30-day readmissions; reviews previous hospital record
confers patient/family and with interdisciplinary team to create an
effective and realistic transition plan.
- Proactively identifies barriers to care progression and
transition and works with multi-disciplinary team to resolve
timely.
- Addresses complex clinical and social situations efficiently in
order to avoid unnecessary admissions, improper level of care
utilization, and delays in transition. Reviews and modifies plan of
care.
- Assures timely transition to lower level of care.
- Assesses the need for follow up appointments and when
applicable communicates to patient/family prior to transition.
- Assures necessary paperwork for post-acute transfers to comply
with state and federal regulatory requirements.
- Identifies ED high utilizers and makes appropriate care plans
and referrals to community resources.
- Identifies patient and families with complex psychosocial
issues (social determinants of health) and refers to health care
team as appropriate.
- Communicates with Financial Counselors regarding uninsured,
underinsured and makes referrals, as appropriate.
- Makes appropriate and timely referrals and completes
documentation to comply with state and federal regulatory
requirements.
- Identifies patients appropriate for case management
intervention by reviewing the electronic health record (EHR) and
meeting with patients and collaborating with staff and
physicians.
- Follows locally determined resources and workflows for patient
transfers. Actively participates in ongoing department operations:
- Identifies new system, processes, protocols and/or methods to
improve practices.
- Actively contributes to the creation of cost-effective
practices that ensure the best patient/provider experience,
effective resource utilization, and safe outcomes.
- Effectively communicates with Care Management colleagues for
safe transitions.
- Actively aware and manages all communications (email, KDS,
Policies & Procedures, Handoffs, and other) and participates in all
department meetings.
- Uses effective interpersonal and communication skills to
promote customer service with internal and external customers.
- Develops and maintains positive, productive, and professional
relationships with the healthcare team and representatives of
community agencies.
- Relates with tact and respect to all customers with diverse
cultural and socioeconomic backgrounds without personal
judgment.
- Be a positive participant, actively engaged in all department
operations.
- Willingly provides and accepts direct, constructive feedback to
and from colleagues and the leadership team. Actively uses
effective communication skills with colleagues to resolve issues in
a timely manner. EDUCATION:
- Equivalent experience will be accepted in lieu of the required
degree or diploma.
- Bachelor's: BS in one of following: Nursing or Health related
field or equivalent education/experience CERTIFICATION & LICENSURE:
- RN-Registered Nurse of California Upon Hire TYPICAL EXPERIENCE:
- 3 years of recent Case Manager experience in Acute Care SKILLS
AND KNOWLEDGE:
- 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.
- Awareness of healthcare reimbursement systems: HMO, PPO, PPS,
CMS, value-based reimbursement models, and alternative payment
systems preferred.
- Working knowledge of laws, regulations, and professional
standards affecting case management practice in an integrated
delivery system: including but not limited to: CMS, Title 22, CHA
Consent Manual, CDPH and TJC.
- A broad knowledge base of post-acute levels of care and
associated regulatory compliance requirements.
- General understanding of coding and DRG assignment process
preferred.
- 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 patients,
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.
- Strong verbal and written communication skills and negotiation
skills
- Must have excellent time management skills to develop organized
work processes in a high-volume environment with rapidly changing
priorities.
- Intermediate computer and technology 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. PHYSICAL ACTIVITIES
AND REQUIREMENTS:
See required physical demands, mental components, visual activities
& working conditions at the following link: Job Requirements
Pay Range: $59.23 - $79.95 / hour
The salary range for this role may vary above or below the posted
range as determined by location . click apply for full job
details
Keywords: Sutter Health, Merced , Care Manager II, Acute, Registered Nurse, Executive , Delhi, California
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