RN Utilization Review Full-time
John Muir Health

RN - Case Manager - WCMC - AS Utilization Management - Full Time - 8 Hour - Days

John Muir Health San Miguel, CA 94598, US
$89.23 - $121.58 / hour
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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:

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

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 know ledge of common diagnoses and procedures and the impact this w ill have to patients/families and their ability to manage their care outside of the hospital. Specialized know ledge 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 know ledge of geriatrics and the impact to health and function in the aged as w ell as a working know ledge 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, Allscripts, InterQual, and Microsoft Outlook.

work schedule of Sunday to Wednesday (week 1) Sunday-Thursday (week2)

Work Shift:

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

Pay Range:

$89.23 - $121.58

Hourly

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:

36

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