Care Manager; RN

Overview

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This is a Stanford Health Care job.

• Inpatient & SNF Utilization Management & Care Coordination
• Support proactive hospital discharge planning, transfers, and redirections through collaborative care planning.
• Develop individualized care plans for all complex case management patients, including regular updates with distribution throughout the care team.
• Proactively and collaboratively interface with HMOs, physicians, internal staff and family members to assist in developing a well-rounded care plan.
• Complete health risk assessments for selected senior patients as needed.
• Serve as a liaison between hospital, health plan, providers, caregivers, family, and the patient.
• Identify opportunities to improve utilization, quality of care, access issues and physician profiling.
• Act as a resource for provider and patient education as necessary.
• Reduce avoidable inpatient and SNF bed days through telephonic & in person concurrent review, proactive assessment of barriers to discharge, and collaboration with key parties to facilitate safe and timely discharge or transition.
• Apply standard clinical criteria, document decisions and issue related member and/or provider correspondence.
• Ensure seamless and safe transition of care, through inpatient and SNF bed-side visits, post discharge coordination with members, providers and ancillary services.
• Referral to telephonic case management, if appropriate.
• High Risk Member Complex Case Management:
  Proactively review Health Risk Assessments and at-risk patient populations for identification of patients appropriate for case management.
• Provide regular feedback to providers, inpatient case managers, and utilization management coordinators on the appropriateness of complex case management referrals.
• Develop and implement care coordination services for complex patients as needed, including scheduling appointments, home health, DME, transportation, financial assistance, and linkages with community resources.
• Identify and refer high-risk members to delivery system chronic disease care programs to improve quality of care.
• Maintain daily electronic case management case list and effectively use case management software programs as designated.
• Attend weekly interdisciplinary care team meetings to discuss complex cases and integrate input from the entire team.
• Meet production standards:
  Adhere to SHC Health Plan policy and procedures; manage a caseload of approximately 50-150 complex and/or rising risk case management patients.
• Provide telephonic and/or onsite case management for members requiring a higher level of complex case management, including periodic visits at the member’s home or provider settings.
• Complete comprehensive assessment of clinical & non-clinical risk factors impacting member’s health status.
• Develop and coordinate implementation of individualized, member-centered care plans, involving member, care givers, providers and other stakeholders to ensure alignment, including scheduling appointments, home health, DME, transportation, coordinating financial assistance, and linkages with community resources.
• Effective coordination and communication with Medical Directors and clinical staff.
• All other duties as assigned including department-specific functions and responsibilities; meet departmental review and documentation standards for work assignments; adhere to the policy and procedure of assigned hospital(s).
• Build and maintain appropriate relationships on behalf of SHC Health Plan.
• Attend departmental and company meetings as indicated by management, including developing and/or presenting reports to Board directors, health plans, medical groups and other committees.
• Performs other duties as assigned and participates in organization projects as assigned.
• Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.

• High School Diploma or GED or equivalent.
• BSN degree from accredited university.

• Minimum of 2 years case management in…