Pediatric Inpatient Care Case Manager (RN)

UCSF Health, AG; Oakland (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

The Pediatric Nurse Case Manager at UCSF Health coordinates resources and services to meet each patient’s needs while overseeing discharge planning and utilization review. This role participates as an active member of the interdisciplinary team and contributes to program development and quality improvement initiatives.

They provide age-appropriate assessments, interpretations of data, and delivery of interventions, communicating effectively with patients and families from diverse backgrounds

Qualifications

• Possesses a Bachelor's Degree in a Healthcare related field.
• Knowledge and abilities essential to the successful performance of the duties assigned to the position.
• Demonstrates resourcefulness, superior written and oral communication, diplomacy, organizational and analytic skills.
• Self-directed, assertive and creative in problem solving, systems planning and patient care management in a high volume work environment.
• Basic computer skills
• Ability to work effectively and collaboratively with interdisciplinary teams.
• This position requires flexibility to orient and work at all UCSF Medical Center locations.

Responsibilities

• Oversees and coordinates complex discharge planning needs for assigned patients in collaboration with other interdisciplinary team members, assuring a safe discharge plan is developed and implemented in a timely manner
• Reviews prospectively, concurrently and retrospectively all inpatients for appropriateness of admission, level of care and determines appropriate length of stay.
• Collaborates with physicians, social workers, support liaisons and other interdisciplinary team members to assess, plan and coordinate patient care needs.
• Monitors patient's length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs.
• Educates patient / families and other healthcare providers regarding utilization management and discharge planning options.
• Performs utilization review using InterQual criteria for assigned service line.
• Participates in denial review for assigned service line.
• Acts as a liaison between insurance medical director and attending physician for peer to peer reviews in cases of denied coverage.
• Provides the requested clinical information to insurance organizations to assure reimbursement.
• Participates in quality improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection.
• Participates on clinical process improvement teams within the department, services lines and hospital.
• Participates in department program planning including goal setting, program development, systems development and improvement.
• Oversees and directs activities delegated and performed by the Support Liaison.

Skills

Resourcefulness

Written and oral communication

Diplomacy

Organizational skills

Analytic skills

Problem solving

Systems planning

Patient care management

High volume work environment

Education

Bachelor's Degree in Healthcare related field

Master's Degree in Nursing or Healthcare related field (preferred)

Tools

Basic computer skills

Job description

The Pediatric Nurse Case Manager at UCSF Health coordinates resources and services to meet each patient’s needs while overseeing discharge planning and utilization review. This role participates as an active member of the interdisciplinary team and contributes to program development and quality improvement initiatives.

They provide age-appropriate assessments, interpretations of data, and delivery of interventions, communicating effectively with patients and families from diverse backgrounds