Case Manager

DEFINITION
Under general direction, coordinates a continuum of care for a selected group of patients from admission through discharge; assures that patients and families proceed efficiently through the course of hospitalization; moves patients through the hospital system in a cost effective manner resulting in the optimal discharge plan; and performs other duties as assigned.
CLASS CHARACTERISTICS
Incumbents in this class are responsible for screening patient post-admission, ongoing review of patient medical records pertaining to the quality of patient care, maximizing reimbursement for services provided and provide optimal discharge planning.
POSITION QUALIFICATIONS
A combination of appropriate education and experience that would likely provide the required knowledge and abilities.
Education
Associate of Science Degree in Nursing
Experience
Two (2) years experience preferred in UM, DC planning, Case Management or equivalent, preferably in an acute hospital setting.
Licensure
Possession of current California RN license required
Current BLS certification
KNOWLEDGE & ABILITIES
Knowledge of:
InterQual guidelines
Payor source documentation requirements and governmental regulations affecting reimbursement.
Hospital nursing principles, methods, and commonly used medical procedures.
Common patient disease processes, and the usual methods for treating them.
Medical terminology, hospital nursing facility routine, and commonly used equipment.
Identification of potential discharge needs.
Community resources; hospital nursing facility organization and the interrelationship of various clinical and diagnostic services.
Ability to:
Evaluate the medical record to assess appropriateness of acute hospitalization as related to intensity of service and severity of illness
Make recommendations regarding continued stay necessity, appropriateness of the level of the delivery of care.
Identify discharge needs. Assess available resources and formulate appropriate discharge plan.
Communicate documentation needs in a manner that promotes cooperation.
Gather and analyze data and prepare reports and recommendations.
Work effectively with physicians, other health providers, outside payor sources, community resources, and the general public.
Relate positively with patients and families; demonstrate crisis intervention skills.
Collaborates with other nursing personnel, physicians and health care professionals regarding the plan of care.
Assess patient/family needs for post discharge care. Plans and implements quality, efficient discharge plan, enabling patient to function at their highest level of independence.
Fulltime/10 hour/Day shifts/