Nurse (Case Manager)
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POST DATE 8/31/2016
END DATE 12/19/2016
Santa Barbara, CA
JOB DESCRIPTIONThe Case Manager is responsible for compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual review of the Utilization Management Plan and assisting with the coordination of the Utilization Management Committee. The Case Manager follows the Case Management/Utilization Program that integrates the functions of utilization review and management along with resource management into a singular effort to ensure, based on patient assessment, care is provided in the most appropriate setting utilizing medically indicated resources.
ESSENTIAL FUNCTIONS OF CASE MANAGER
* Promote the mission, vision, and values of the organization
* Facilitate team meetings that foster interdepartmental collaboration with the patient and their family as deemed necessary, this includes multidisciplinary meetings and Utilization Review/Case Management meetings. Provides input in such meetings regarding utilization management and discharge planning.
* Responsible for evaluating and screening potential admissions to the facility when appropriate.
* Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage.
* Communicate daily with admissions personnel regarding admissions and discharges to various units.
* Ensures that a quality of care is maintained or surpassed by collecting quality indicators and variance data and reporting the data to the appropriate department; reports and identifies data that indicates potential areas for improvement of care and services provided within the system.
* Educates physicians and staff regarding appropriate level of care/utilization issues.
* Oversight and evaluation of the discharge planner/ utilization review nurse.
* Perform and oversee needs analysis and planning. Work with executive leadership to ensure targets are met for the annual operating plan/financial
PROFESSIONAL REQUIREMENTS OF CASE MANAGER
* Adhere to dress code, appearance is neat and clean.
* Complete annual education requirements.
* Maintain patient confidentiality at all times.
* Report to work on time and as scheduled.
* Wear identification while on duty.
* Maintain regulatory requirements, including all state, federal and local regulations.
* Represent the organization in a positive and professional manner at all times.
* Comply with all organizational policies and standards regarding ethical business practices.
* Communicate the mission, ethics and goals of the organization.
* Attend regular staff meetings and in-services.
QUALIFICATIONS OF CASE MANAGER
* Current registered nurse licensure in the state of California
* Knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage
* Minimum of three (3) years acute setting, HMO or other areas of experience.
KNOWLEDGE, SKILLS, AND ABILITIES OF CASE MANAGER
* Knowledge of nursing services and insurance coverage preferred
* Strong organizational and interpersonal skills
* Ability to determine appropriate course of action in more complex situations
* Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
* Ability to manage multiple and simultaneous responsibilities and to prioritize scheduling of work
* Ability to maintain confidentiality of all medical, financial, and legal information
* Ability to complete work assignments accurately and in a timely manner
* Ability to communicate effectively, both orally and in writing
* Ability to handle difficult situations involving patients, physicians, or others in a professional manner
* Knowledge of the continuum of care and utilization process.
* Ability to document Case Management plans in a clear and concise manner.