Case Manager - Sharp Chula Vista - FT - Days

sharp; Chula Vista (CA); On-site; USD 99,000 - 138,000; Full time

Job summary

Sharp HealthCare in California is seeking an RN CM II to assess, develop and monitor patient care plans within inpatient and emergency settings. You will collaborate with physicians, social workers and the care team to ensure appropriate care levels while balancing utilization and cost considerations.

Requirements include a California RN license, 2 years of clinical experience, and 3 years in case management or utilization review. Strong leadership and precepting skills are valued in this role.

Qualifications

• Bachelor's Degree in Nursing or equivalent degree.
• 2 Years recent pertinent clinical experience as defined by the CBA.
• 3 Years acute care nursing experience or case management experience.
• 3 Years case management, utilization review, care coordination experience.
• California Registered Nurse (RN) - CA Board of Registered Nursing - REQUIRED

Responsibilities

• Assess, develop, implement, coordinate and monitor a comprehensive plan of care in inpatient and ED.
• Balance clinical needs with regulatory/financial utilization review demands.
• Mentor and precept new hires (CMI, SW, LVN Care Coordinators and CRCs).
• Collaborate with interdisciplinary team to achieve quality outcomes.

Education

Bachelor's Degree in Nursing

Job description

Hours :

Shift Start Time: 8 AM Shift End Time: 4:30 PM

AWS Hours Requirement:

8/80 - 8 Hour Shift

Weekend Requirements:

Every Other

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):$71.830 - $78.080 - $100.330

The stated pay scale reflects the range as defined by the collective bargaining agreement between Sharp HealthCare and Sharp Professional Nurses Network, United Nurses Associations of California/Union of Health Care Professionals, NUHHCE, AFSME, AFL-CIO. Placement within the range is based on years of RN experience.

What You Will Do

The RN CM II assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. This position requires the ability to combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the appropriate setting and level of care. The position creates a balance between individual clinical needs with the efficient and cost-effective utilization of resources while promoting quality outcomes. This position requires critical thinking and advanced problem-solving and time management skills. The CM II will partner with ICM leadership to mentor and precept new hires (CMI, SW, LVN Care Coordinators and CRCs).

Required Qualifications

• Bachelor's Degree in Nursing or equivalent degree.
• 2 Years recent pertinent clinical experience as defined by the CBA.
• 3 Years acute care nursing experience or case management experience.
• 3 Years case management, utilization review, care coordination experience.
• California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED

Preferred Qualifications

• Master's Degree
• Certified Case Manager (CCM) - Commission for Case Manager Certification -PREFERRED
• Accredited Case Manager (ACM) - American Case Management Association (ACMA) -PREFERRED

Essential Functions

Professional development

The RN CM II will: Actively participates in the performance planning, competency and individual development planning process. Maintain current knowledge of case management, utilization management, and discharge planning, as specified by Sharp, federal, state, and private insurance guidelines.

Core principles

The RN CM II will make timely referrals to ensure that the patient is receiving the appropriate care, in the appropriate setting and using the appropriate utilization standards as set by community and professional standard as adopted by the medical staff. The RN CM II will assure that the patients from all age groups proceed efficiently through the course of hospitalization and beyond through the continuum of care. The RN CM II will relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following and/or enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, collaborate and accept direction. The RN CM II performs other duties as needed.

Organizational relationships

The RN CM II will work closely with the healthcare team in reaching unit, facility, and system/network organization goals including reductions in length of stay, decreasing denials, improvement of care transitions, and reduction in avoidable readmissions, improved patient experience, and other quality initiatives. In the emergency departments, the RN CM II will work collaboratively with other members of the interdisciplinary team to develop relationships and provide preadmission status recommendations for admissions as well as implement a comprehensive, integrated discharge plan from the emergency department(ED) for patients who are being discharged to a lower level of care. The RN CM II will recommend and document patient classification (status and level of care) for all admissions utilizing established criterion sets. The RN CM II has accountability for maintaining compliance contractual and regulatory compliance with medical groups as applicable and the hospital. The RN CM II will have excellent interpersonal skills demonstrated by the ability to work effectively with individuals and or teams across disciplines.

Care coordination and discharge planning

Within 24 hours of admission the RN CM II will interview each patient/family for anticipated needs post hospitalization. The plan and interventions will be documented in the electronic medical record (EMR) and other supporting case management software. The RN CM II will ensure patient choice is obtained and documented in accordance with all state and federal regulatory requirements. The RN CM II will develop and document a plan for the day and plan for the stay with patient, family, providers, and nursing staff. The RN CM II will be responsible for leading the daily care coordination (multidisciplinary) rounds, update the