Acute Care Case Manager

Quick Facts

• Role: Acute Care Case Manager (Care Manager II, Acute)
• Schedule: Part time, Days (8 hours), variable days; every weekend
• Weekly hours: 24
• Pay range: $82.48 to $115.46 per hour

Description

Responsible for care coordination and care transition planning throughout the acute care patient experience. Works with physicians, utilization management, medical social work, and bedside nursing to support timely progression and appropriate discharge planning to prevent unnecessary admissions or readmissions. Collaborates with patients, families, interdisciplinary teams, payers, and community resources, including managing complex clinical and social situations in the Emergency Department to avoid unnecessary admissions.

Responsibilities

• Coordinate care and transitions across the continuum using effective resource coordination
• Prevent unnecessary admissions or readmissions through timely level-of-care decisions
• Conduct utilization review and support appropriate utilization of resources
• Communicate and facilitate care between patients/families, physicians, nursing, quality, ancillary services, third-party payers, review agencies, claims/finance, medical directors, and contracted providers
• When assigned to the Emergency Department, address complex clinical and social situations efficiently

Requirements

• Graduate of an accredited school of nursing
• RN license in California upon hire
• 2 years of experience in acute care case management or health plan case management/utilization management
• Broad knowledge of health care delivery and case management in a managed care environment
• Comprehensive knowledge of utilization review, levels of care, and observation status
• Awareness of healthcare reimbursement systems (HMO, PPO, PPS, CMS, value-based reimbursement, alternative payment systems)
• Working knowledge of laws, regulations, and professional standards affecting case management (CMS, Title 22, CHA Consent Manual, CDPH, TJC)
• Knowledge of post-acute levels of care and related regulatory compliance requirements
• General understanding of coding and DRG assignment preferred
• Strong communication and negotiation skills
• Excellent time management in a high-volume, rapidly changing environment
• Intermediate computer and technology skills
• Ability to work independently and use sound judgment with physicians, payers, and patients/families
• Ability to work effectively in teams and promote service excellence

Benefits

• Benefits available