SLH Case Manager RN

Alameda Health System; San Leandro (CA); On-site; USD 88,000 - 147,000; Full time

Job summary

Alameda Health System is seeking a registered nurse to perform comprehensive case management for patients with complex health and social needs. The role focuses on discharge planning, care coordination, and community resource linkage to prevent deterioration and reduce costly hospitalizations.

The ideal candidate has an active California RN license, BLS certification, and 2+ years in acute care or utilization review, with experience in case management or home health preferred.

Qualifications

• Associates degree in a related field; Bachelor's degree preferred.
• Minimum two years' experience in acute care or utilization review; varied case management/community health experience preferred.
• Licenses/certifications: BLS (AHA) and CA RN license; preferred: Public Health Nurse, Case Management, or Home Health.

Responsibilities

• Conducts discharge planning assessments with attention to patient age and cultural context.
• Coordinates disposition and transfer readiness with physicians and payers; completes TAR and related docs.
• Connects patients/families to community resources and helps plan for post-discharge care.
• Educates patients on illness, discharge planning, and self-management with nursing support.
• Provides community resource coaching and disease self-management guidance.
• Reassesses patient condition, revises care plans, and coordinates services with local resources; advocates for services and benefits.
• Reviews caseload for medical necessity, ongoing stays, and resource use; coordinates with interdisciplinary team for transitions.
• Mentors staff on care coordination, training, and quality improvement; educates on Advance Directives and POLST.
• Understands insurance/compliance standards; coordinates denials with physicians; documents treatment plans and discharge information as required.

Skills

Two years acute care experience

Utilization review

Education

Associate's degree in related field

Bachelor’s Degree preferred

Job description

About this position

Job Summary: The SLH Case Manager RN is responsible for providing comprehensive case management services to clients identified with complex health conditions and social challenges that are at risk for health status decline. The goals and focus of these service efforts are to provide timely delivery of intensive case management servicesduring the transitional period beginning with hospitalization and culminating with integration back into the community setting to prevent further health deterioration and reduce the need for more costly services such as acute care hospitalization and to develop self-management skills that improve his or her long-term health status. Performs related duties as required.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

• 1. Conducts discharge planning assessments in a timely and complete manner. Assessments and interventions; considers the age and cultural or religious influences of the patient/family.
• 2. Coordinates disposition of Medi-Cal, self-pay, and out-of-plan patients, including working with physician to determine readiness for transfer, securing placement and completing TAR and other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed.
• 3. Encourages patients to develop realistic plans. Makes direct contact with or refers patient/family to appropriate community resources. Maintains knowledge of currently available resources in the community.
• 4. Guides the patient in understanding the nature of his illness; confers with patients and their families to prepare for the patients’ discharge.
• 5. Provides community resource education and coaching, focusing on individual client self-management principles. This includes preparing for provider visits and supporting the disease management principles introduced by the nursing team.
• 6. Reassesses the client’s condition when changes occur and revises the care plan as appropriate. Coordinates and arranges for needed services with appropriate local resources. Serves as client advocate to secure services and financial benefits.
• 7. Reviews all the patients in his/her caseload in the following areas; admission criteria for medical necessity and appropriateness of care; continued stay criteria for medical necessity and appropriateness of care; resource Management issues; other issues including concerns involving under/over utilization, avoidable days and quality issues. Coordinate daily with interdisciplinary team in transitioning patient throughout hospital stay; provides discharge planning services, working with patient/family and receiving multi disciplinary input, so that an appropriate plan is developed enabling a patient to go home, or facilitates the relocation of the patients to another setting.
• 8. Serves as a mentor and educator to the organization’s health care team assisting with care coordination, training, and quality improvement activities; provides staff education regarding Advance Directives and POLST when requested.
• 9. Understands insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients. Takes appropriate action when cases do not meet criteria - coordinates denials with the attending physician, and the UR physician advisor. Prepares case reports; documents treatment plan, progress notes and discharge summary related information as required by Medicare, MediCal, Title 22 and other mandated regulations according to Department standards. Keeps required statistics.

Qualifications:

• Education: Associates’s degree in a related field. Bachelor’s Degree preferred.
• Minimum Experience: Two years related in acute care facility and/or utilization review training.
• Minimum Experience: Varied clinical experience or experience in case management/community health preferred.
• Preferred Licenses/Certification: Public Health Nurse, Case Management, or Home Health.
• Required Licenses/Certifications: BLS - Basic Life Support Certification - issued by AHA-American Heart Association.
• Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.

Pay Range $64.15 - $106.92

The pay range for this position reflects the base pay scale for the role at Alameda Health System. Final compensation will be determined based on several factors, including but not limited to a candidate’s experience, education, skills licensure and certifications, departmental equity, applicable collective bargaining agreements, and the operational needs of the organization. Alameda Health System also offers eligible positions a generous comprehensive benefits program.

Salary Information

$64.15 - $106.92Hourly Wage