Pediatric Inpatient Case Manager: Discharge & Coordination

UCSF Health, AG; San Francisco (CA); On-site; USD 110,000 - 150,000; Full time

Job summary

UCSF Health Pediatric Nurse Case Manager coordinates resources and services in response to patient needs and fiscal realities, performs utilization review and oversees coordination of complex discharge planning for assigned case load. The Nurse Case Manager is an active member of the interdisciplinary team contributing to team goal setting and quality improvement initiatives.

The Nurse Case Manager provides age-appropriate assessments, interpretation of data, and delivery of interventions,

Qualifications

• Bachelor’s degree in a healthcare-related field is required.
• Recent experience in case management, utilization review, or discharge planning.
• Strong written and oral communication, diplomacy and organizational skills.

Responsibilities

• Oversees and coordinates complex discharge planning for assigned patients with the interdisciplinary team.
• Reviews inpatient admissions for appropriateness of care and length of stay.
• Collaborates with physicians, social workers and staff to coordinate patient care needs.
• Monitors length of stay and resource utilization within benefits for clinical and psychosocial needs.
• Communicates with patients, families and staff from diverse backgrounds.
• Educates patients/families and healthcare providers on utilization management and discharge planning options.
• Performs utilization review using InterQual criteria for assigned service line.
• Participates in denial reviews and peer-to-peer discussions with insurance representatives.
• Contributes to quality improvement and department program planning.
• Oversees activities delegated to Support Liaison and participates in department tasks.

Skills

Case management

Utilization review

Discharge planning

Interdisciplinary collaboration

Communication

Analytical skills

Problem solving

Flexibility

Education

Bachelor's Degree in Healthcare related field

Master's Degree in Nursing or Healthcare related field

Tools

InterQual criteria

Electronic Health Records

Job description

UCSF Health Pediatric Nurse Case Manager coordinates resources and services in response to patient needs and fiscal realities, performs utilization review and oversees coordination of complex discharge planning for assigned case load. The Nurse Case Manager is an active member of the interdisciplinary team contributing to team goal setting and quality improvement initiatives.

The Nurse Case Manager provides age-appropriate assessments, interpretation of data, and delivery of interventions,