SRS-Inpatient Case Manager II - Utilization Management - Per Diem - Days Job at

Hours: Shift Start Time: 8 AM Shift End Time: 4:30 AM AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: As Needed On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $60.265 - $77.761 - $95.258 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. What You Will Do: The SRS RN CM II assesses, develops, implements, coordinates, and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker, and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. This position requires the ability to combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the appropriate setting and level of care. The position creates a balance between individual clinical needs with the efficient and cost-effective utilization of resources while promoting quality outcomes. Required Qualifications: Bachelor's Degree in Nursing 3 Years acute care nursing experience or case management experience 3 Years recent case management, utilization review, care coordination experience California Registered Nurse (RN) - CA Board of Registered Nursing - REQUIRED Preferred Qualifications: Master's Degree in Nursing Certified Case Manager (CCM) - Commission for Case Manager Certification - PREFERRED Essential Functions: The SRS RN CM II will actively participate in the performance planning, competency, and individual development planning process. Maintain current knowledge of case management, utilization management, and discharge planning, as specified by Sharp, federal, state, and private insurance guidelines. The SRS RN CM II will make timely referrals to ensure that the patient is receiving the appropriate care, in the appropriate setting and using the appropriate utilization standards as set by community and professional standards as adopted by the medical staff. The SRS RN CM II will work closely with the healthcare team in reaching unit, facility, and system/network organization goals including reductions in length of stay, decreasing denials, improvement of care transitions, and reduction in avoidable readmissions, improved patient experience, and other quality initiatives. Within 24 hours of admission, the SRS RN CM II will interview each patient/family for anticipated needs post-hospitalization. The plan and interventions will be documented in the EMR (e.g., Cerner), and case management software (e.g., Allscripts). The SRS RN CM II will document and initiate discharge plan including early referrals and authorization for SNF, Rehab, homecare, DME, and infusion services. The SRS RN CM II will prepare patient/family for discharge. Document expected discharge date per protocol and arrange discharge pick-up appointment with family or significant other. The SRS RN CM II will ensure effective and safe patient handovers to the next level of care; work closely with ambulatory care manager (ACM) at the system level, in clinics, and homecare and sub-acute liaisons. The SRS RN CM II will facilitate increased volume of cases discharged early in the day to improve capacity management. The SRS RN CM II will collect and document avoidable days' information in appropriate case management software, e.g., Allscripts. The SRS RN CM II will participate in venues to reduce barriers to discharge. The SRS RN CM II will collaborate with Clinical Resource Coordinators (CRCs/clinical assistants) to assure appropriate referrals for care and services are directed to appropriate network providers. The SRS RN CM II will oversee preparation, delivery, and documentation of non-coverage letters. The SRS RN CM II will identify and escalate potential quality variances to management and document per guidelines. Knowledge, Skills, and Abilities: Advanced PC, data management, and analysis skills required, (experience with InterQual, and or MCG and Allscripts an Asset). An understanding and knowledge of payer eligibility and reimbursement regulations and impact on the continuum of care. Knowledge of use of community resources to coordinate safe discharges from acute care and the ED settings. Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, and across disciplines. Excellent communication and negotiation skills as demonstrated in oral and written forms. Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external. Organizational and time management skills, as evidenced by capacity to prioritize multiple tasks. Ability to mentor and lead a team. Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class. #J-18808-Ljbffr