RN Full-time
Sonoma Valley Hospital

Case Manager (RN)

Sonoma Valley Hospital Sonoma, CA 95476, US
$59.94 - $82.42 / hour
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Overview

The Case Manager leads care coordination throughout hospital levels of care. In this role the Case Manager completes assessments  and transition care planning that reflects the wishes and needs of the patient and their family. This position also assists physicians and finance with the management of  resource utilization through the use of medical necessity criteria. 

Responsibilities

Completes medical necessity criteria for both inpatient and outpatient visits, documenting the reasons when the patient status is not supported in the database and reporting discrepancies during weekday morning huddles.

 

Completes assessments and discharge plans for inpatients. Provides consultation for outpatient and observation patient stays when requested. Assists with discharge planning for these patients as needed.

 

Builds provider networks and community resources and provides updates to the clinical team.

 

Assists in the case management functions of the preoperative preparation and discharge planning for Inpatient or outpatient surgeries, specifically the Total Joint Program as able.

 

Leads morning huddles focusing on patient status, expected LOS and providing the tentative plan for discharge.

 

Completes LACE tool for Inpatients and reports Lace scores to hospitalist group for furthering discussions regarding palliative care and readmission reduction.

 

Role models values and actively  applies patient engagement strategies; documents information on the white boards including what matters to the patient. Completes the MY Plan for all inpatients and uses the "journey" program to provide discharge planning education  to patients and their families.

 

Conducts readmission interviews with readmitted patients to determine the reasons for returning to the hospital. Bases care plan on  information gleaned from interview. Completes follow-up phone calls for high risk patients as time allows.

 

Assists with requests for clinical information for medical necessity insurance reviews and arranges peer to peer calls  when an appeal is warranted.

Qualifications

Education: Graduate of an accredited RN programExperience: At least 2 years clinical patient care on a medical surgical unit, specialty unit, or currently working in a case management setting.Licenses & Certifications: Licensed RN in the State of California, certification in Case Management or Utilization Review at hire or within 3 years of hire if no experience in case management.Required Skills & Knowledge: Good written and verbal communication skills. Ability to manage priorities and workflow. Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm. Ability to deal effectively with a diversity of individuals at all organizational levels. Good judgement with the ability to make timely and sound decisions. Proficiency with computers and electronic forms of communication.

Compensation

Actual compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Eligible roles also qualify for a comprehensive benefits package.

Minimum:

USD $59.94

Maximum:

USD $82.42

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$86.13 - $110.25 / hour
ABOUT MARINHEALTH Are you looking for a place where you are empowered to bring innovation to reality? Join MarinHealth, an integrated, independent healthcare system with deep roots throughout the North Bay. With a world-class physician and clinical team, an affiliation with UCSF Health, an ever-expanding network of clinics, and a new state-of-the-art hospital, MarinHealth is growing quickly. MarinHealth comprises MarinHealth Medical Center, a 327-bed hospital in Greenbrae, and 55 primary care and specialty clinics in Marin, Sonoma, and Napa Counties. We attract healthcare’s most talented trailblazers who appreciate having the best of both worlds: the pioneering medicine of an academic medical center combined with an independent hospital's personalized, caring touch. MarinHealth is already realizing the benefits of impressive growth and has consistently earned high praise and accolades, including being Named One of the Top 250 Hospitals Nationwide by Healthgrades, receiving a 5-star Ranking for Overall Hospital Quality from the Centers for Medicare and Medicaid Services, and being named the Best Hospital in San Francisco/Marin by Bay Area Parent, among others. Company: Marin General Hospital dba MarinHealth Medical Center Compensation Range: $86.13 - $110.25 Work Shift: 12 Hour (days) (United States of America) Scheduled Weekly Hours: 36 Job Description Summary: The purpose of the Clinical RN role is to assess, plan, implement, evaluate, direct, and appropriately delegate to ensure the delivery of safe, quality patient care. This registered professional nurse will function within the full scope of RN licensure, according to the California Nursing Practice Act. The Clinical RN will provide assessment, development, and implementation of the care plan, evaluating the effectiveness of that care, directing emergency interventions, and collaborating with physicians, team members, and others to optimally manage patient care in the interest of the patient, acting as a patient advocate when necessary. Job Requirements, Prerequisites and Essential Functions: Job Specifications: Education: Sufficient education to obtain a valid California RN license Experience: Clinical RN II, either: 6 months to 1-year experience as a Clinical RN I at MarinHealth Medical Center; or Possession of the clinical experience as identified in the appropriate unit -specific job description addendum. License and Certifications: California RN license Required at hire Basic Life Support Required at hire Integrative Agitation Management (IAM) Required within 30 days of hire Prerequisite Skills: Ability to demonstrate proficiency in all items of the Staff Nurse Skills Criteria at the conclusion of the probationary period Demonstrated leadership and delegation skills Demonstrated oral and written communication skills Demonstrated ability to organize and prioritize work; time management skills Ability to work collaboratively with team members, other teams, physicians, and departments Ability to read, speak, write, understand and follow English verbal and written instructions. Primary Customer Served (Age Specific Criteria): Varies by department assigned. Refer to Unit Specific Addendum Employees in this position must be able to demonstrate the knowledge and skills necessary to provide care and/or service based on the physical, psycho/social, educational, safety, and related criteria appropriate to the age of the patients served in his/her assigned service area. Patient Privacy (HIPAA Compliance): Employees in this position have access to protected health information. The protected health information a person in this position can access includes demographics, date of service, insurance/billing, medical record summary information, and all other information that may be contained in patient records. This position requires patient health information to perform the functions outlined as part of this position description. Duties And Responsibilities: Essential (Not Modifiable) Consistently demonstrates the ability to transfer scientific knowledge from social, biological and physical sciences in applying the nursing process as follows: Formulates a nursing diagnosis through observation of the patient's physical condition and behavior, and through interpretation of information obtained from the client and others, including the health team Formulates age specific care planning, in collaboration with the patient, which ensures that direct and indirect nursing care services provide for the patient's safety, comfort, hygiene, and protection, and for disease prevention an restorative measures Perform skills essential to the kind of nursing action to be taken, explains the health treatment to the patient and family, and teaches the client and family how to care for the health needs Evaluates the effectiveness of care planning through observation of the patient's physical condition and behavior, signs and symptoms of illness, reactions to treatment, and through communication with the patient and team members, and modifies the plan as needed Acts as the patient's advocate, as circumstances require, by initiating action to improve health care or to change decisions or activities which are against the interests or wishes of the patient and by giving the patient the opportunity to make informed decisions about health care before it is provided. Demonstrates leadership by supervising, directing and delegating appropriately to care team members. Delegates tasks to subordinates based on the legal scopes of practice of the subordinates and on the preparation and capability needed in the tasks to be delegated, and effectively supervises nursing care being given by subordinates Demonstrates clinical expertise by serving as a clinical expert, role model, and clinical and educational resource to the team, patients, and families. May act as a mentor and assist in the training and development of less experienced staff members Demonstrates professional accountability for nursing practice. Accommodation: Qualified applicants with disabilities may request reasonable accommodation during the application process by contacting Human Resources at 415-925-7040 or TalentAcquisition@mymarinhealth.org . C.A.R.E.S. Standards: MarinHealth seeks candidates ready to model our C.A.R.E.S. standards—Communication, Accountability, Respect, Excellence, Safety—which foster a healing, trust-based environment for patients and colleagues. Health & Immunizations: To protect employees, patients, and our community, MarinHealth requires measles, mumps, varicella, and annual influenza immunizations as a condition of employment (and annually thereafter). COVID-19 vaccination/booster remains strongly recommended. Medical or religious exemptions will be considered consistent with applicable law. Compensation: The posted pay range complies with applicable law and reflects what we reasonably expect to pay for this role. Individual pay is set by skills, experience, qualifications, and internal/market equity, consistent with MarinHealth’s compensation philosophy. Positions covered by collective bargaining agreements are governed by those agreements. Equal Employment: All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sexual orientation, gender identity, protected veteran status or disability status, and any other classifications protected by federal, state, and local laws.