John Muir Health

Not-for-profit health system

RN Case Manager - AS Utilization Management

Medical, Clinical & VeterinaryPosted on Nov 10

Full-timeConcord, NH, USA$89.23 - $121.58 /hrIn-person

About the Job

Requirements

A bachelor's degree from an accredited school of nursing is required.
An active Registered Nursing license from the California Board of Nursing is required.
Basic Life Support certification from the American Heart Association is required.
Strong written and verbal communication skills are required, including the ability to motivate teams.
Knowledge of Medicare and Medi-Cal guidelines and benefit resources relevant to hospitalization and transition planning is required.
Working knowledge of common diagnoses and procedures and their effects on patients, families, and ability to manage care outside the hospital is required; specialized knowledge may be needed in some practice areas.
Knowledge of individual and family development across the lifespan, including cultural and spiritual influences on health care, is required.
General knowledge of commercial coverage plans and covered benefits, and understanding of reimbursement models and their effects on care delivery, patient management, and reimbursement, including ACOs, DRGs, and full risk, is required.
Understanding of criteria, rules, and regulations for inpatient, observation, and outpatient levels of patient management is required.
Knowledge of geriatrics and its effects on health and function in older adults, and working knowledge of chronic or progressive diseases such as CHF, COPD, diabetes, and end-stage renal disease, is required.
Understanding of the inpatient social worker's role and palliative care resources is required.
Ability to plan, organize, manage time, and prioritize work collaboratively is required.
Ability to work independently and as part of a multidisciplinary team is required.
Problem-solving and conflict-resolution skills are required.
Ability to work respectfully and creatively with clients of diverse functional abilities and social, economic, and cultural backgrounds while supporting client autonomy and safety is required.
Leadership skills to delegate, provide direction and guidance to staff, and hold others accountable are required.
Ability to learn and work with EPIC, MIDAS, Allscripts, and Microsoft Outlook is required.

Responsibilities

Assess, plan, implement, monitor, evaluate, and coordinate care to meet patients' health care needs during hospitalization and transition back to the community, in coordination with the interdisciplinary health team.
Advocate for appropriate utilization of resources as an inpatient case manager.
Work within the full scope of nursing practice with a specialized focus on care coordination, compliance, transition management, education, and utilization management.

Desired Qualifications

Two years of case management experience or equivalent work experience is preferred.
Three years of medical/surgical nursing experience is preferred.
Three years of critical care nursing experience is preferred.
Accredited Case Manager certification from the American Case Management Association or Certified Case Manager certification from the Commission for Case Manager Certification is strongly preferred.

Job Description:

The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient’s health care needs through hospitalization and transition back to the community and does this in coordination with the interdisciplinary health team.
The RN Case Manager is expected to function within the full scope of the nursing practice with specialized focus on care coordination, compliance, transition management, education, and utilization management.

Education:

Bachelor's Degree Accredited School of Nursing Required

Experience:

2 years Case Management or Equivalent Work Experience Preferred
3 years Nursing - Medical/Surgical Preferred
3 years Nursing - Critical Care Preferred

Certifications/Licensures:

RN Registered Nursing - California Board of Nursing Required
BLS Basic Life Support - American Heart Association Required
ACM Accredited Case Manager - ACMA American Case Management Association or
CCM Certified Case Manager - CCMC Commission for Case Manager Certification Strongly Preferred

Skills:

Strong written and verbal communication skills. Effectively motivates teams.
Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning.
Working knowledge of common diagnoses and procedures and the impact this will have to patients/families and their ability to manage their care outside of the hospital. Specialized knowledge may be required for certain areas of practice.
Knowledge of individual and family development over the life span, and the influences of cultural and spiritual values in health care.
General knowledge of commercial coverage plans and usually covered benefits. Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements such as ACOs, DRGs, Full Risk, etc.
Strong understanding of the criteria, rules and regulations around Inpatient, Observation and Outpatient levels of patient management. Strong knowledge of geriatrics and the impact to health and function in the aged as well as a working knowledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc. Clear understanding of the role of the inpatient Social Worker and Palliative Care Resources.
Ability to plan, organize, manage time and prioritize work in collaboration with others.
Ability to work independently and as a part of a multidisciplinary team.
Effective problem solving and conflict resolution skills.
Ability to work respectfully and creatively with clients of diverse functional abilities, social, economic, and cultural backgrounds to support both client autonomy and client safety.
Leadership skills to delegate and provide direction/guidance to staff and hold others accountable.
Able to learn and work in a variety of computer programs, including EPIC, MIDAS, Allscripts, and Microsoft Outlook.

Fixed Schedule:
Week 1: Sun-Wed
Week 2: Sun-Thurs

Work Shift:

08.0 - 08:00 - 16:30 No Waive (United States of America)

Pay Range:

$89.23 - $121.58Hourly

Offer amounts are based on demonstrated/relevant experience and/or licensure.

Pay will be adjusted to the local market if hired outside of the Bay Area.

Note: Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting. The work shift will contain the word ‘exempt’ on it.

Scheduled Weekly Hours:

About the Company

John Muir Health

Not-for-profit health system

John Muir Health is a not-for-profit health system serving the East Bay in Northern California. It runs a network of over 1,000 primary care and specialty physicians, 6,000+ employees, and medical centers in Concord and Walnut Creek, including Contra Costa County’s only trauma center and a Behavioral Health Center. It connects hospitals, outpatient clinics, and physician groups to provide primary care, emergency services, and specialties such as cancer, cardiovascular care, neurosciences, orthopedics, and high-risk obstetrics, with partnerships to UCSF Health and Stanford Children’s Health for advanced care. Its goal is to help patients reach their optimal health through coordinated, patient-centered care and a collaborative culture among physicians, staff, and volunteers.

Company size: 1,001-5,000
Company stage: Not listed
Total funding: Not listed
Headquarters: Concord, CA
Founded: Not listed

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