Acute Care Case Manager II Escondido, California

Responsible for assessing and monitoring appropriate safe discharge plans by promoting quality, cost-effective options, and interventions for patients in an acute care setting and as the patient transitions through the continuum of care. Through a collaborative process, participates in interdisciplinary patient rounds in the assigned patient care unit with the ability to lead discussions and direct plans. Ensures medical appropriateness criteria are met for the level of care provided and is documented from admission through discharge. Reevaluates the plan of care and ensures continued appropriateness based on the patient's changing needs and condition as well as to identify potential delays, determine effectiveness, and patient/family satisfaction. Maintains working knowledge of specialized case and utilization management methodologies and practices; applies concepts to everyday practice. Provides decision support for the treatment care team regarding documentation elements required by regulatory agencies and payers, e.g., Medicare, Medi-Cal, Health Plans, and Contracts; helps the team understand the interrelationship of reimbursement with efficient and appropriate utilization of resources and services. Completes required continuous training and education, including department-specific requirements to maintain current knowledge of department and hospital policies, procedures, billing practices, compliance plans, federal and state regulations, insurance regulations, and accrediting body standards concerning case and utilization management. Understands and adheres to the California Nurse Practice Act, The American Nurses Association (ANA) Code of Ethics for Nurses, the ANA Bill of Rights for Registered Nurses, and the ANA Scope and Standards of Practice for Nursing.

Job Requirements

Minimum Education:

As required by certification and/or licensurePreferred Education:

Bachelor's Degree and/or National Certification in Utilization Review or Case ManagementMinimum Experience:

1 - 3 years of directly related RN experiencePreferred Experience:

3 - 5 years acute care nursing experience; Completion of Utilization Review/Case Management courseRequired Certification:

American Heart Association recognized BLS - Healthcare ProviderPreferred Certification:

Not ApplicableRequired License:

Current CA RN LicensePreferred License:

Not ApplicableCurrent employees are not eligible for hiring incentives. We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status, or any other characteristic protected by law.

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