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Case Manager

Company: Sutter Healthcare
Location: mountain view
Posted on: May 3, 2021

Job Description:

The Case Manager is responsible for Care Coordination, Care Transitions, Discharge/Transition Planning and Utilization Management throughout the acute care patient experience. Case Manager coordinates care at admission and throughout the stay to ensure that patient outcomes are optimal, that evidence based care guidelines are followed and documented and the organization's costs are controlled. Case managers are both patients' advocate and the organization's stewards. The objective is to optimize the use of hospital resources by supporting timely patient movement to the appropriate level of care in a manner that supports patient/family. The Case Manager uses standardized criteria to evaluate admission, level of care and readiness for discharge. Discharge/Transition planning is provided for all patients to assess post discharge needs and to resolve transition care issues and barriers impeding progress towards goals. The Case Manager helps drive change by identifying areas where performance improvement is needed. The Case Manager works in collaboration with the Medical Social worker and interdisciplinary team to assure timeliness in care coordination and discharge planning throughout the hospital stay. Oversees the management of acute patient populations across the care continuum with primary focus to provide coordinated, timely and integrated care.

The Case Management Department 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."

Education:

Bachelor's BSN - Bachelors degree in Nursing required

Master's in nursing, case management or other health related field preferred

Master's - In lieu of 3 years clinical experience noted below, Masters degree in Case Management with clinical residency from acute medical/surgical practice area at a Sutter Health Affiliate required

Licensures and Certifications:

Registered Nurse - State Licensure RN Required

RNC Case Management - RNC-CM National Certification in Case Management (i.e. ACM, ANA RN-BC Case Management) upon hire or within 18 months of hire date for experienced case managers. Newly trained case managers: National certification as noted above, within 24 months of hire preferred

Basic Life Support Certification BLS Required

Experience:

Three or more years clinical experience in acute medical/surgical or critical care practice area required

Department-Specific Experience:

Minimum of three (3) years in acute medical/surgical/ED/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 nursing area may be considered for employment at directors discretion required

Previous Acute Case Management experience required. Specifically in discharge planning and community resources required

Experience utilizing electronic InterQual/MCG or other standardized criteria strongly preferred

Experience with clinical assessment for patient with complex medical, emotional and social needs required

Experience using an electronic medical record system

Skills and 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

Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families

Demonstrates commitment to service excellence in all patient, family and employee interactions and in performing all job duties

Performs duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety, cost efficiency, and a commitment to the CQI process

Excellent verbal and written communication skills

Demonstrated leadership skills

Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components

Strong PC skills

Working knowledge of InterQual criteria

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 patient experience

Ability to work effectively in a fast paced environment, directing patient care services within and external to hospital setting

Keywords: Sutter Healthcare, Mountain View , Case Manager, Other , mountain view, California

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