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Case Mgr Utilization RN in Bakersfield, California For Sale

Case Mgr Utilization RN
Date/Time:13 Nov, 04:16 a.m. EST
Type: Medical, For Sale - Private.

Title: Case Mgr Utilization RN Location: Bakersfield, CA Works collaboratively w/ an MD to coordinate & screen for the appropriateness of admissions & Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts w/ the family, patient & other disciplines to coordinate a safe & acceptable discharge plan. Functions as an indirect caregiver, patient advocate & manages patients in the most cost effective way w/out compromising quality. Transfers stable non-members to planned Health care facilities. Responsible for complying w/ AB xxxx, Post Stabilization notification. Complies w/ other duties as described. Must be able to work collaboratively w/ the multidisciplinary team ,multitask & in a fast pace environment. Essential Functions: - Plans, develops, assesses & evaluates care provided to members - Collaborates w/ physicians, other members of the multidisciplinary health care team & patient/family in the development, implementation & documentation of approp, individualized plans of care to ensure continuity, quality & approp resource use - Recommends alternative levels of care & ensures compliance w/ fed, state & local requirements - Assesses high risk patients in need of post-hospital care planning - Develops & coordinates the implementation of a discharge plan to meet patient's identified needs; communicates the plan to physicians, patient, family/caregivers, staff & approp community agencies - Reviews, monitors, evaluates & coordinates the patient's hospital stay to assure that all approp & essential svcs are delivered timely & efficiently - Participates in the Bed Huddles & carries out recommendations congruent w/ the patient's needs - Coordinates the interdisciplinary approach to providing continuity of care, including Utilization mgmt, Transfer coord, Discharge planning, & obtaining all authorizations/approvals as needed for outside svcs for patients/ families - Conducts daily clinical reviews for utilization/quality mgmt activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient & non-KFH facilities - Acts as a liaison between in-patient facility & referral facilities/agencies & provides case mgmt to patients referred - Refers patients to community resources to meet post-hospital needs - Coordinates transfer of patients to approp facilities; maintains & provides required documentation - Adheres to internal & external regulatory & accreditation requirements & compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA & DOL - Educates members of the healthcare team concerning their roles & responsibilities in the discharge planning process & approp use of resources - Provides patients w/ education to assist w/ their discharge & help them cope w/ psychological problems related to acute & chronic illness - Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities - Reviews, analyses & identifies utilization patterns & trends, problems or inapprop utilization of resources & participates in the collection & analysis of data for special studies, projects, planning, or for routine utilization monitoring activities - Coordinates, participates & or facilitates care planning rounds & patient family conferences - Participates in committees, teams or other work projects/duties as assigned Qualifications: This position is a SCNSC bargaining unit represented position. Basic Qualifications: - Minimum two (2) years of clinical experience as an RN in an acute care setting required - Bachelor's degree in nursing or healthcare related field preferred OR current equivalent related work experience - Graduate of an accredited school of nursing required - Current and valid California RN license required - Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning and case management - Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.) - Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills Preferred Qualifications: - BSN, BA - CCM or RNCM - Experience in inpatient case management processes. -Basic PC Skills: Word, Elect. Med Rcd Notes: - Rotating Weekends - Responsible for coordination of inpatient case management processes for Kaiser Kern members.

State: California  City: Bakersfield  Category: Medical
Medical in California for sale

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