We are looking for a Care Manager RN II for the Case Management Department at Santa Rosa Memorial Hospital.
Location: Santa Rosa, CA
Work Schedule: Full Time - 80 Biweekly Hours
Shift: 8-hour, Days
Manages specific patients throughout their admission to ensure the availability of sufficient clinical and medical center resources. Communicates on a daily basis with medical staff, medical center personnel and outside resources to ensure the appropriate utilization of resources according to clinical and financial standards. Monitors the medical record for variances to clinical and financial standards and intervenes to achieve the optimum outcome for the patient and the medical center. Is able to incorporate risk management and infection control knowledge for the purpose of assisting the healthcare team to achieve a desired outcome. Identifies issues, which expose the organization to liability and financial risk, and assists to minimize the risk by collaborating with management, medical staff and medical center personnel. Provides payor/utilization review organizations with concurrent retrospective utilization review required for reimbursement.
- Supports the values and mission of Providence Health and practices the core values when interacting with those served by the Medical Center.
- Oversees the multidisciplinary assessment, development and implementation of a comprehensive plan of care, discharge goal, and evaluation of patients’ clinical course through the continuum.
- Coordinates utilization activities of patient care using UR criteria (InterQual) - to ensure appropriate admission, length of stay, resource management, and maximum payer reimbursement.
- Identifies high-risk patients and refer to social services and / or community case management.
- Communicates appropriate information to third party payers.
- Coordinates activities related to discharge planning with patient, family, physician, and other health care team members.
- Works with Nursing to facilitate transfers to other facilities including facility and transport authorizations if necessary (REFERENCE EMTALA).
- Serves as a resource to physicians, admitting department, financial counselors, business office.
- Documents assessment and discharge plan in the medical record.
- Has knowledge of regulatory requirements in Continuum of Care and clinical areas of responsibility (TJC, TITLE 22, CONDITIONS OF PARTICIPATION).
- Assures appropriate documentation for receiving maximum reimbursement under regulatory guidelines and contractual agreements, specifically Medicare, Medi-Cal, HMO’s and other payer sources.
- Implements denial process when necessary with appropriate denial letters as per CMRI and / or payer source requirements.
- Coordinates Inter-Disciplinary care conferences as indicated. Actively participates in extended length of stay meetings using InterQual criteria and addressing pain management, end of life, and ethics issues.
- Participates in hospital / health-system / community teams as indicated.
- Identifies referrals to infection control, risk and quality management.
- Participates in collecting, monitoring, reporting and analyzing of data as requested.
- Demonstrated knowledge of Microsoft PC applications, internet/web based applications.
- Admission Care Manager:
- Strong clinical, communication and multitasking skills.
- Pass Interrater Reliability Test with a score of 88% or above.
Minimum Position Requirements:
- Bachelor's Degree in Nursing.
- Coursework/Training - Environmental Orientation due within 30 days of hire.
- Coursework/Training - Case Management Competency due within 90 days of hire.
- Coursework/Training - General Nurse Competency due within 30 days of hire.
Experience: 3 years Acute nursing experience, with evidence of progressive clinical experience preferred, or Case management experience.
- Current California RN License by evidence of Primary Source Verification.
- BLS Certification.
Preferred Position Qualifications:
Providence St. Joseph Health (Providence) has worked for decades to improve health and quality of life in California's North Bay region, starting in Sonoma County, where the Sisters of St. Joseph of Orange opened the doors of Santa Rosa Memorial Hospital in 1950. Today, we continue the mission begun by the Sisters to those we serve through an integrated spectrum of primary, urgent, acute, outpatient, palliative care and regional referral services. Sonoma County facilities aligned with Providence include the 278-bed Santa Rosa Memorial Hospital, the region's only Level II trauma center. In addition, the 80-bed Petaluma Valley Hospital and 43-bed Healdsburg Hospital are secular (non-religious) affiliates of Providence. Our services also encompass three Urgent Care centers, Hospice of Petaluma, Memorial Hospice and North County Hospice, the Annadel Medical Group doing business as St. Joseph Health Medical Group, as well as the St. Joseph Home Care Network (post-acute care services). We act as a regional referral hub for outlying hospitals, while also providing outpatient behavioral health care, education to promote health and prevent chronic disease, rehabilitation, oral health care, community benefit programs, and more, all fostering health and quality of life throughout the area.
Providence provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Providence complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Positions specified as "on call/per diem" refers to employment consisting of shifts scheduled on as "as needed basis" to fill in for staff vacancies.
Company: Sonoma County Entities
Category: Case Management
Req ID: R341885