RN Case Manager
Oakland, CA
LanceSoft
5x8 hrs, Days

**MUST HAVE DISCHARGE PLANNING EXPERIENCE - Please specify where they've had this experience**

CASE MANAGER RN NEEDED -

5/8s
Every Other Weekend

Certification Requirements:
CA RN LICENSE
BLS

Experience: 5+ Years of RN Case Management experience
**PER THE MANAGER MUST HAVE Inpatient Acute Case Management (Case Manager Hospital experience

JOB DUTIES:
Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through effective resource coordination. The goals of this role are to include the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self determination while coordinating in a timely and integrated fashion. He/She collaborates with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical and social situations efficiently in order to avoid unnecessary admissions.

JOB ACCOUNTABILITIES:

Patient Initial and Continued Assessment.
Reviews initial physician admission care plan. Gathers additional medical, psychosocial, and financial information from the patient/family interview, medical record assessment, physicians, and other health care providers. Determines moderate or high risk level for readmission. Conducts a screening for ancillary supportive services, including but not limited to Palliative Care Services needs.
Functionally supervises and actively leads the health care team in developing comprehensive cost-effective care coordination plans that meet the clinical needs of our patients.
Identifies and refers quality and risk management concerns to appropriate level for patient safety reporting and trending. Directs and oversees the Case Management Assistants to determine preferences for post-acute care services.

Utilization Management.
Reviews medical record to ensure patient continues to meet level of care (LOC) requirements and that chart documentation supports LOC determination and assignment. Works with Attending Physicians to confirm necessary documentation to support level of care (LOC). Expedites transition planning for patients who no longer require acute level of care.
Monitors length of stay (LOS) and outliers requiring additional resources and/or focus.
Collaborates with financial counselor for delivery of inpatient stay denials.
Assures delivery of Medicare Important Message within 48 hours of discharge/transition and no less than 4 hours of actual discharge/transition.
Actively participates in patient rounds following the standard work as developed and collaborates with interdisciplinary team to assure timely transition.
Follows policies and procedures for Physician Advisor referrals. Utilizes appropriate escalation process when discussing level of care (LOC) requirements with providers. Consistently documents in the EHR and other electronic software.
Maintains current knowledge of CMS and Joint Commission Transitions of Care requirements, Conditions of Participation (COPs), and other regulatory requirements.
Effectively follows Observation patients, re-evaluates and collaborates with attending physician for admission or transition to appropriate level of care for the patient.

Care Coordination/ Care Transitions.
Formulates a transition plan after reviewing available/appropriate care options and obtaining input, and collaborating with the patient/family and physician, health care team, payers, and community based support services.
Performs, documents, and communicates assessment findings to health care team.
Screens 30-day readmissions; reviews previous hospital record confers patient/family and with interdisciplinary team to create an effective and realistic transition plan.
Proactively identifies barriers to care progression and transition, and works with multi-disciplinary team to resolve timely.
Addresses complex clinical and social situations efficiently in order to avoid unnecessary admissions, improper level of care utilization, and delays in transition. Reviews and modifys plan of care.
Assures timely transition to lower level of care. Assesses the need for follow up appointments and when applicable communicates to patient/family prior to transition. Assures necessary paperwork for post-acute transfers to comply with state and federal regulatory requirements.
Identifies ED high utilizers and makes appropriate care plans and referrals to community resources.
Identifies patient and families with complex psychosocial issues (social determinants of health) and refers to health care team as appropriate.
Communicates with Financial Counselors regarding uninsured, underinsured and makes referrals, as appropriate.
Makes appropriate and timely referrals and completes documentation to comply with state and federal regulatory requirements.
Identifies patients appropriate for case management intervention by reviewing the electronic health record (EHR) and meeting with patients and collaborating with staff and physicians
Follows locally determined resources and workflows for patient transfers.
Actively participates in ongoing department operations.
Identifies new system, processes, protocols and/or methods to improve practices.
Actively contributes to the creation of cost effective practices that ensure the best patient/provider experience, effective resource utilization, and safe outcomes.
Effectively communicates with Care Management colleagues for safe transitions.
Actively aware and manages all communications (email, KDS, Policies & Procedures, Handoffs, and other) and participates in all department meetings. Uses effective interpersonal and communication skills to promote customer service with internal and external customers.
Develops and maintains positive, productive, and professional relationships with the healthcare team and representatives of community agencies.
Relates with tact and respect to all customers with diverse cultural and socioeconomic backgrounds without personal judgment.
Be a positive participant, actively engaged in all department operations.
Willingly provides and accepts direct, constructive feedback to and from colleagues and the leadership team. Actively uses effective communication skills with colleagues to resolve issues in a timely manner.

COVID-19 Vaccine: Unknown

Flu Vaccine: Unknown
Submittals:High
Job Requirements & Qualifications
Previous Charge Experience : Preferred
Years of Experience : 2
Patient Ratio Experience : 10
Charting System Experience : -
Charting System Name : Epic
Community Hospital Experience : -
LTAC Experience : -
Trauma Level I Experience : -
Trauma Level II Experience : -
Travel Experience Required : -
Certifications : BLS, CA RN LicenseSkills : Acute Hospital, Care coordination, Discharge Planning
Unit Details
Staffing & Scheduling
Scheduling Type : -
Patient Ratios Days : 15
Patient Ratios Nights : -
Patient Ratios Weekends : 25
Float Required : -
Call Required : -
Weekend Coverage : True
Number of Weekend Shifts Per Contract : -
Pre-Approved Time Off : -
Orientation Hours : -
Facility & Patient Care Details
Patient Age Groups : Adults, Geriatrics
Daily Census : -
Number of Visits Per Day : -
Number of Rooms : -
Number of Beds : -
Additional Unit Information
Interdisciplinary Support : -
Patient Diagnoses : -
Special Procedures/Unit Details : -
Special Equipment : -

#Tier3 Travel Compliance

Local candidates:
50-mile radius rule

RN Licensure:
Uploaded Nursys within the last 2 weeks
with Valid CA State License

Certifications:
Uploaded any applicable certifications with valid expiration dates

Certifications must be AHA or ARC

References:
2 references obtained within the last year

Return Staff/Travelers:
No separation time required. Former manager(s) name needed on application

Experience:
Unless otherwise stated, at least 2 years of experience required

BG/Licensure Hits:
Any hits with supporting documentation will need to be disclosed to seek approval from facility HR to proceed with application

RTO Policy:

Max RTO:
7 days per contract

Holiday RTO:
New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day. Holidays begin at 7:00 PM the night before the holiday, and end at 7:00 AM the day after the holiday

Only 1 holiday per contract can be requested

Compliance:

Onboarding:

Must complete labs within 3-5 days of contract signing

Work History Verification: 7-Year Work History Verification Required for all candidates.
Candidates must provide accurate work history information going back 7 years from their start date and may also be required to provide documentation or contacts for the verifications if we are unable to verify any positions

Deadline:
All compliance documents due 10 days prior to start

Re-Orientation
: re-orientation only required if travelers have been separated for 6+ months since last shift and IF orientation was completed at Alta Bates Summit Medical Center

Modules:

An average of 1-5 hours spent on modules and are factored into NBO.

Modules are completed during orientation, and module hours vary by specialty

Modules are recorded through e-learning

50-mile radius ruleRN Licensure: Uploaded Nursys within the last 2 weeks with Valid CA State LicenseCertifications: Uploaded any applicable certifications with valid expiration datesCertifications must be AHA or ARCReferences: 2 references obtained within the last yearReturn Staff/Travelers: No separation time required. Former manager(s) name needed on applicationExperience: Unless otherwise stated, at least 2 years of experience requiredBG/Licensure Hits: Any hits with supporting documentation will need to be disclosed to seek approval from facility HR to proceed with applicationRTO Policy:Max RTO: 7 days per contractHoliday RTO: New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day. Holidays begin at 7:00 PM the night before the holiday, and end at 7:00 AM the day after the holidayOnly 1 holiday per contract can be requestedCompliance:Onboarding:Must complete labs within 3-5 days of contract signingWork History Verification: 7-Year Work History Verification Required for all candidates. An average of 1-5 hours spent on modules and are factored into NBO.