RN Case Manager

Center for Elders' Independence; Oakland (CA); On-site; USD 104,000 - 160,000; Full time

Job summary

Center for Elders’ Independence is seeking an RN Case Manager to coordinate and facilitate resource management for CEI participants in hospital and SNF settings, ensuring smooth transitions and optimal disposition.

The role requires strong clinical judgment, collaboration with physicians and the IDT, knowledge of CEI benefits, and the ability to navigate regulations; experience with EMR and case management is expected.

Qualifications

• BSN in Nursing from an accredited program is required.
• Current California RN license is mandatory.
• CPR certification is required.
• 3-5 years of case management experience is expected.
• CCM certification is preferred.
• Familiarity with CEI benefits and Nurse Practice Act regulations.

Responsibilities

• Assess and coordinate care for CEI participants in hospital/SNF settings.
• Develop and evaluate treatment plans with providers.
• Authorize appropriate hospital or SNF stays in a timely manner.
• Serve as CEI liaison for hospital during business hours.
• Collaborate with physicians and IDT for optimal discharge and continuity of care.
• Maintain ED notifications and coordinate with care teams for smooth transitions.
• Identify best placement level and guide IDT decisions for SNF placement.
• Ensure compliance with policy, privacy, and organizational standards.

Skills

Interpersonal communication

Time management

Critical thinking

Collaboration

Adaptability

Education

BSN in Nursing

CA RN license

CPR certificate

CCM Preferred

Tools

Electronic Medical Records

Microsoft Office

Job description

RN Case Manager

The Center for Elders’ Independence is a PACE (Program of All-Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, and promoting autonomy, quality of life and the ability of individuals to live in their communities.

The Position: The Coordination of Care Service Center RN Case Manager is responsible for monitoring and facilitating appropriate resource management of CEI participants in Hospital and SNF settings and for collaboration with others to assure optimal participant disposition. Understands placement options, makes recommendations for alternative levels of care and is responsible for smooth transition and discharge from Hospital and Emergency Department.

The annual pay range for the CCSC RN Case Manager position at Center for Elders’ Independence is $104,332 to $159,629. Placement within the range is determined based on job-related factors such as relevant experience, skills, abilities, internal equity, and market data, consistent with CEI’s annual compensation review and established compensation practices.

DUTIES AND RESPONSIBLITIES:

• Assesses and evaluates care provided to CEI members in non-CEI settings.
• Develops and evaluates appropriate treatment plans in conjunction with provider.
• Assures appropriate, timely review and authorization for hospital or SNF stay.
• Acts as CEI single point of contact and liaison for hospital during business hours.
• Reviews clinical information and collaborates with internal and external physicians and other providers for optimal and timely disposition.
• Communicates frequently with CEI physician and IDT as needed to assure and execute optimal discharge and continuity of care plan.
• Develops collaborative, productive relationships with hospital and SNF health care providers to achieve optimal participant care and outcomes across the continuum.
• Knowledgeable regarding contracts and CEI benefit coverage.
• Able to identify appropriate level of care for SNF placement, providing guidance for IDT.
• Collaborates with CEI physician to oversee care of CEI participants at SNF’s.
• Monitor’s and documents participants’ care according to established skilled care guidelines.
• Assists with development, review and revision of departmental policy and procedures which support positive outcomes and organizational objectives.
• Open to best practice model suggestions.
• Offers input and complies with department standards of care and practice as well as quality improvement activities.
• Investigates participant concerns as identified and offers satisfactory resolution regarding case management role.
• Consistently complies with organizational Code of Conduct by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state, and local laws and regulations, accreditation and license requirements.
• Models ethical behavior; adheres to organizational policies and guidelines; maintains confidences; admits mistakes; conducts work with honesty; shows consistency in words and actions and follows through on commitments.

• Demonstrates on openness to creative and innovative approaches to providing service.

• Checks for new hospital admissions and ED visits via Direct Line Tele-Response fax transmission.
• Recording ED notifications and e-mailing messages to Clinic IDT.
• Locating contracted SNF, obtaining physician approval/authorization for participants who require short term placement.
• Requests hospital documentation for hospital stays and ED visits are reviewed by the provider.
• Ensuring status updates are transmitted via e-mail to all relevant parties as they occur for any participant going to or being discharged from the ED, hospital, and/or SNF.
• Performs other related duties as required or assigned to support the efficient operation of the department and organization.

QUALIFICATIONS:

• BSN in Nursing required from accredited school of nursing.
• CCM Preferred.
• Current California Nursing RN license required.
• CPR certificate required.
• 3-5 years of Case Management experience required
• PACE work experience preferred.
• Understanding of Nurse Practice Act and all other local, state, and federal regulations.
• Demonstrated strong interpersonal communication skills.
• Experience working with electronic medical records and intermediate/advanced computer skills (Microsoft Office Suite) required.
• Ability to perform duties in heavy workload, fluctuating environment.

The above job description is intended to communicate the general function of the mentioned position and by no means shall be considered an exhaustive or complete outline of the specific tasks and functions that will be required. CEI reserves the right to change job descriptions, location assignments, and or work hours as required by the needs of the program. All employees are expected to perform their duties within their ability as required by the job and/or as requested by management.