Case Manager - Transition Planner - Sharp Memorial Hospital Day Shift

5 days ago Be among the first 25 applicants

Hourly Pay Range (Minimum - Midpoint - Maximum): $56.580 - $70.170 - $83.760

The stated pay scale reflects the range as defined by the collective bargaining agreement between Sharp Health Care and Sharp Professional Nurses Network, United Nurses Associations of California/Union of Health Care Professionals, NUHHCE, AFSME, AFL-CIO. Placement within the range is based on years of RN experience.

The RN CM I 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. This position requires critical thinking and advanced problem‑solving and time‑management skills.

• 2 Years Recent acute care nursing experience, case management experience or equivalent experience in the healthcare setting.
• California Registered Nurse (RN) - CA Board of Registered Nursing

• Bachelor's Degree in Nursing or equivalent degree.
• Master's Degree
• Certified Case Manager (CCM) - Commission for Case Manager Certification
• Accredited Case Manager (ACM) - American Case Management Association (ACMA)

Professional development:
The RN CM I will actively participates 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.

Core principles:
The RN CM I 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 standard as adopted by the medical staff. The RN CM I will assure that the patients from all age groups proceed efficiently through the course of hospitalization and beyond through the continuum of care.

The RN CM I will relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following and/or enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, collaborate and accept direction. The RN CM I performs other duties as needed.

Organizational relationships:
The RN CM I 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.

In the emergency departments, the RN CM I will work collaboratively with other members of the interdisciplinary team to develop relationships and provide preadmission status recommendations for admissions as well as implement a comprehensive, integrated discharge plan from the emergency department(ED) for patients who are being discharged to a lower level of care.

The RN CM I will recommend and document patient classification (status and level of care) for all admissions utilizing established criterion sets.

The RN CM I has accountability for maintaining compliance contractual and regulatory compliance with medical groups as applicable and the hospital.

The RN CM I will have excellent interpersonal skills demonstrated by the ability to work effectively with individuals and or teams across disciplines.

Within 24 hours of admission the RN CM I will interview/assess each patient/family for anticipated needs post hospitalization.

The RN CM I will ensure patient choice is obtained and documented in accordance with all state and federal regulatory requirements.

The plan and interventions will be documented in the electronic medical record (EMR), and case management software.

The RN CM I will develop and document a plan for the day and plan for the stay with patient, family, providers, and nursing staff.

The RN CM I will be responsible for leading the daily care coordination (multidisciplinary) rounds, update the plan, and facilitate necessary coordination of services.

The RN CM I will document and initiate discharge plan including early referrals and authorization for LTAC, SNF, Rehab, homecare, DME and infusion services.

The RN CM I will prepare patient/family for discharge. Document expected discharge date per protocol and arrange discharge pick up appointment with family or significant other.

In collaboration with SW partner, the RN CM I will follow standards for routine…