Case Manager

Overview

The Case Manager serves as a key member of the patient care delivery team in a Magnet Recognized large tertiary academic medical center with level one trauma designation, STEMI receiving center designation, and Comprehensive Stroke Center and Chest Pain Center accreditation. Works efficiently in a fast-paced environment and uses clinical expertise, discretion and independent judgement in performing the nursing process (assessment, care planning, intervention, evaluation) within a patient-centered care professional practice model and as it relates to case management functions.

Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria (medical necessity) are met for level of care provided and is documented from admission through discharge. Practices in a collaborative health care environment to oversee implementation of an interdisciplinary plan of care with an individualized discharge plan that is comprehensive and best meets the continuing healthcare needs of the patient.

Reevaluates plan of care and ensures continued appropriateness based on the patient s changing needs and condition. Functions within the expectations of a professional nurse and meets nursing excellence standards to achieve and maintain Magnet Recognition as outlined by the American Nurses Credentialing Center. Represents nursing as an empowered profession and embraces new knowledge, innovations and improvements. Exhibits positivity and serves as a change agent and minimizes resistance to change in the workforce, clinical practice and operational setting.

Engages in opportunities to influence decision-making for bedside clinical practice by participating in professional governance councils, committees, task forces and staff meetings. Performs other duties as needed.

• Maintain a well-thought-out interdisciplinary plan of care with an individualized discharge plan that meets continuing healthcare needs.
• Reevaluate plan of care and ensure continued appropriateness based on patients  changing needs and condition.
• Oversee implementation of the plan of care in collaboration with the care team.
• Practice within the professional nurse role and nursing excellence standards to achieve Magnet Recognition.
• Participate in governance councils, committees, task forces and staff meetings to influence bedside clinical practice.
• Perform other duties as needed.

• Bachelor of Science degree in nursing (BSN) required.
• Minimum two years of hospital nursing experience required.
• Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred.

• Basic knowledge of case and utilization management practice and methodologies and state and federal healthcare regulations and accreditation required.
• Ability to speak, read and write English (Spanish preferred) with professional quality; operate computer, printer and software programs (e.g., Microsoft Office Suite, Outlook, electronic medical record, electronic event reporting program).
• Relate and communicate positively, effectively and exhibit professional behavior; work calmly under pressure; follow policies; teach and collaborate; accept direction; think critically; work independently; perform basic math and statistical functions; manage multiple assignments; organize and prioritize workload; problem solve; recall information with accuracy; pay close attention to detail; hear and read words clearly; see readouts on computer screens and documents necessary to position.

• Active and unrestricted California Registered Nurse (RN) license required.
• Current Basic Life Support (BLS) certification issued by the American Heart Association required.
• Nationally recognized certification in Utilization Management or Case Management preferred.

Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, excellence, humility, integrity, justice, teamwork and wholeness.

Loma Linda University Health is a Seventh-day Adventist, faith and values based Christian institution. Candidates must understand and embrace the mission, purpose, and identity of Loma Linda and its affiliated entities.

We are an equal opportunity employer committed to the principles of diversity. We provide equal opportunities in all aspects of the employment process to every individual, regardless of gender, race, color, age, national origin, ancestry, physical or mental disability, marital or veteran status, genetic information or any other characteristic protected by law. In addition, we will provide reasonable accommodations for otherwise qualified individuals requesting an accommodation due to a disability.

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