Case Manager

Socket.dev; Pleasanton (CA); On-site; USD 9,722,000 - 13,127,000; Full time

Job summary

Stanford Health Care Tri-Valley is seeking a qualified nurse to review admission appropriateness and coordinate care across the hospital team. You will help identify the appropriate level of care and ensure timely admissions decisions.

You will obtain authorizations, support complex discharge planning, and participate in quality improvement initiatives. A BSN is preferred, RN licensure is required, with 2–3 years acute care and utilization review experience. CI-CARE is emphasized.

Qualifications

• Graduate from an accredited school of nursing required.
• BSN preferred.
• 2+ years acute care nursing experience required.
• 2+ years utilization review in acute care hospital preferred.

Responsibilities

• Review assigned patients for admission appropriateness and level of care within one working day.
• Collaborate with healthcare team to develop and implement treatment plans.
• Act as consultant on patient assessment and care; participate in program development and quality initiatives.
• Coordinate discharge planning and utilization review activities.
• Support denial management and communication with care teams.
• Educate and promote self-management and adherence to care plans.

Skills

Communication skills

Teamwork

Problem solving

Attention to detail

Computer literacy

Education

Registered Nurse licensure

BSN preferred

Tools

Electronic Health Records

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.

A Brief Overview

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 inall ofits 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.