SUMMARY Reporting to the Lead Case Manager Emergency, Care Coordination, this position is accountable for beginning utilization review starting at the time patients access the hospital in the emergency room. The case manager is responsible for utilization review, collaboration with physicians to facilitate disposition to the appropriate level of care within the hospital setting, ER, observation or inpatient using Inter-Qual criteria guidelines. This position also is responsible for the initial assessment of the clinical condition of emergency room inpatient admissions for national evidenced based core measures.
1. Current licensure as a Registered Nurse in the State of California is required.
2. At least 3-5 years of clinical nursing experience in an acute care medical center is required.
3. Utilization review, discharge planning or case management experience and BSN is preferred. CCM national certification is preferred.
4. Knowledge and/or familiarity with community resources, outside professional agencies, federal and state regulations governing hospital and home care as well as understanding the financial structure of health plans and delivery systems is preferred.
5. Self direction, organization, priority setting, critical thinking, problem solving and interpersonal skills to promote teamwork and patient care management starting at the time the patient presents to or accesses the hospital is required.
6. Current American Heart Association (AHA) Healthcare Provider CPR card is required.
7. CCM national certification is preferred.