Case Manager

Stanford Health Care Tri-Valley; Pleasanton (CA); On-site; USD 146,000 - 198,000; Full time

Job summary

Stanford Health Care Tri-Valley is seeking an experienced RN to review admissions, justify care levels, and collaborate with the care team to support patient-centered plans. The role emphasizes utilization review, discharge planning, and contributing to quality improvement initiatives.

Requires RN licensure, BSN preferred, and 2–3 years in acute care with Utilization Review experience. Base pay ranges from $70.57–$95.29 per hour, with competitive benefits and growth opportunities.

Qualifications

• Graduate from an accredited school of nursing.
• RN licensure required; BLS certification expected.
• 2–3 years acute care nursing experience required.
• 2–3 years Utilization Review experience preferred.
• CCM preferred.

Responsibilities

• Review medical information on assigned patients and justify admission within one business day.
• Collaborate with healthcare team to develop and implement patient-centered care plans.
• Act as consultants to clinical teams and participate in quality improvement initiatives.
• Communicate with supervisors, financial counselors, and accounting for service needs.
• Coordinate admission/discharge processes and conduct utilization reviews for appropriate care.

Skills

Nursing

Utilization Review

Interdisciplinary teamwork

Communication

Education

RN Licensure

BSN preferred

Job description

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered.

Day - 08 Hour (United States of America)

This is a Stanford Health Care Tri-Valley job.

Reviews each assigned case for appropriateness of admission and level of care. Acquires authorizations for non-elective admissions, continued stays, and post-acute hospital needs. Assesses patient/family needs for additional resources throughout the hospital stay and communicates identified needs and resources given to all appropriate team members. Population served: Acute medical/surgical patients including neonate, pediatric, adolescent, young adult, middle-age, and geriatric.

Locations

Stanford Health Care Tri-Valley

What You Will Do

• Reviews medical information on all assigned patients and provides clinical justification of the admission using hospital/industry approved criteria within one working day, including identification of the appropriate level of care.
• Responsible for working collaboratively with all healthcare team members to develop and implement treatment plans that support the patient-centered plan of care for both individual patients and the service-line.
• Act as consultants to the clinical team, service lines, and other departments regarding patient assessment and patient care and participate in program development and quality improvement initiatives.
• Communicates accurately with Supervisor, Financial Counselors, Contract Dept., and/or Patient Accounting for pertinent account information or service needs.
• Coordinates with all facets of a patient's admission/discharge or outpatient visit/follow-up; performing utilization review activities, including review of patient charts for timeliness of services as well as appropriate utilization of services; and ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements.
• Consistently manages denials and facilitates the appeals process while keeping the physician and appropriate departments briefed on denial and progress of appeal
• Coordinates activities of high risk patients related to inpatient care goals and 30 days after discharge by home visits and phone calls.
• Determines appropriate discharge options and identifies medical/psychological/social conditions that may require additional therapeutic support/treatment and communicates this to the staff contact at the higher level of care facility.
• Educates, coach and promote self-management skills and patient adherence to treatment plan by utilizing appropriate education methods based on the individualized patient needs, abilities, preferences and readiness to learn with respect to cultural, social, or ethical considerations.
• Actively participates in daily Patient Rounds. Attends staff meetings and serves on hospital wide committees
• Employee must perform all duties and responsibilities in accordance with the C-I-CARE Standards of the Hospital. C-I-CARE is the foundation of Stanford Healthcare Tri – Valley patient-experience and represents a framework for patient-centered interactions

Education Qualifications

• Graduate from an accredited school of nursing Required
• BSN Preferred

Experience Qualifications

• 2+ years to 3 years acute care nursing experience needed Required
• 2+ years to 3 years Utilization Review acute care hospital Preferred

Required Knowledge, Skills And Abilities

• Ability to work independently and function effectively as a member of an interdisciplinary team.
• Basic Computer skills required.
• Strong communication and interpersonal skills
• Strong advocacy and problem-solving skills
• Strong attention to detail
• Knowledge of the principles of growth and development and the ability to assess and interpret data regarding a patient’s status to identify the patient’s needs and appropriate care
• Knowledge of acute care in relation to safety, security and joint commission standards

Licenses and Certifications

• Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure required
• Current American Heart Association Certification for Basic Life Support for Healthcare Providers required
• ACM or
• CCM - Certified Case Manager preferred

These Principles Apply To ALL Employees

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $70.57 - $95.29 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.