Senior RN Case Manager - Full Time - 10 hour shifts - Days - Washington Hospital Healthcare System
Fremont, CA
About the Job
Salary Range: $90.17 - $121.74
The Senior Case Manager functions as a member of the multidisciplinary health care team to facilitate patient movement through the continuum of care and back into the community. The case manager supports the physician and interdisciplinary team in facilitating patient care with the underlying objective of enhancing the quality of the clinical outcomes and patient satisfaction, while managing the cost of care and providing timely and accurate information to payors. As part of the team, the case manager makes decisions regarding utilization management and alternative treatment which reflects cost effectiveness. Provides interface with internal departments and external departments and agencies. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the case manager helps drive change by identifying areas where performance improvement is needed. The role demonstrates leadership for the team and to anticipate the hospital’s needs. In addition to performing the essential functions described, may also be assigned other duties as required.
Qualifications:
- California Registered Nurse License and BLS Certification.
- Bachelor of Science in Nursing or other health related bachelor degree required
- Masters of Science in Nurse Case Management preferred
- Two years of clinical experience as a Registered Nurse preferred
- Current knowledge of reimbursement requirements, level of care, and clinical criteria.
- Clinical Care Guideline knowledge, preferred
- Ability to communicate effectively both verbally and in written form
- Ability to anticipate barriers/challenges and develop plan of success
- Ability to prepare oral and written reports
- Ability to abstract data from medical records, enter into a case management software program
- Basic computer skills required including Excel spreadsheet
- Demonstrates effective interpersonal and communication skills
- Demonstrates flexibility via an ability to adapt to changing priorities
Regulatory/Compliance:
- Demonstrates an understanding of legal and regulatory issues (i/e., HIPPA, EMTALA, The Joint Commission, Centers for Medicare and Medicaid Services (CMS)) impacting the care delivery and reimbursement process.
- Demonstrates understanding of the CMS Conditions of Participation
- Practices within the scope of the California Nurse Practice Act (Section 2725) in all aspects of patient care, promoting safe practice in order to reduce risk.
- Adheres to hospital, divisional, unit-based policies and procedures, and procedures, e.g., attendance rules and chain of command.
Source : Washington Hospital Healthcare System