Description

Job Summary

• Collaborates with the patients and their families, the patient’s physicians, and care providers in coordinating the care of the patient, utilizing skills of advocacy, communication, management of fiscal and material management, regulatory compliance, and education.
• Identifies, facilitates and coordinates the appropriate services, resources, providers and facilities throughout the continuum of
  care.
• Acts as a liaison with physician(s) to assure all covered aspects of treatment are fully documented and ensure patients receive timely, appropriate care during their hospitalization. This position is represented by RCHEA. 

Requirements

RN, Care Manager Job Requirements

• Appropriately delegates tasks and duties when directing and coordinating health care team members, patient care and activities.
  Assures completion of utilization review and management, including quality review, and case review for all third-party payors including Medicare and Medi-Cal.
• Collaborates with the patient, responsible party/caregiver, nurse and attending physician in discharge planning and case management.
• Conducts initial review early in acute care admission on the identified targeted patient population for appropriateness of hospitalization. Monitors appropriate LOS on acute unit for identified patient population. Assures patient movement to lower level of care in timely manner.
• Demonstrates awareness and sensitivity to patient/visitor rights, as identified within the institution, and functions as a patient advocate.
• Demonstrates self-directed learning and participation in continuing education to meet own professional development. Demonstrates an awareness of self-responsibility and accountability for own professional growth and practice.
• Evaluates denials for payment and assists in appeal process.
• Evaluates effectiveness of self, care given by all health care team members, and contributions of systems, environment, and instrumentation in progression of patient toward desired outcomes. - Formulates a goal directed plan of care, based on determined nursing diagnoses and desired patient outcomes. Functions to establish priorities of patient care based on essential patient needs, age of patient and available unit resources of time, personnel, equipment and supplies.
• Gathers and analyzes data, makes recommendations, collaborates with other health care professionals, including Risk Management. Identifies trended problems and educates staff related to pertinent issues.
• Implements care in a knowledgeable, skillful, consistent and continuous manner. Identifies patient/visitor learning needs and implements appropriate measures to meet these.
• Maintains and meets expectations on time for all competencies, license, certifications and education requirements as outlined by local administration, Adventist Health (AH), The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), and all other regulatory agencies.
• Maintains the appropriate documentation of reviews performed, according to pre-established criteria.
• Monitors and evaluates services and outcomes by assessing benefit value to cost, facilitating plan modification as needed, and assessing patient/resident satisfaction and compliance with unit guidelines and regulatory agencies.
• Participates actively in staff development activities for unit and nursing division personnel.
• Participates in development and attainment of unit goals. Participates in peer review, unit quality management and improvement activities, and standards development.
• Performs assessment/data collection in an ongoing and systematic manner, focusing on biophysical, psychosocial and cognitive status, considering the age of the patients served.
• Performs documentation duties on unit and in patient record, which are timely, accurate and concise.
• Performs efficiency in emergency situations, following established protocols, remaining calm, informing appropriate persons, and documenting events.
• Willingly performs other duties and innovations as assigned.