The RN Inpatient Case Manager is responsible for the on-site and telephonic coordination of care for hospitalized HMO patients. This position is also responsible for working closely with physicians, the hospital, and outpatient service producers in coordinating care for Arch Health Partners managed care populations.
This position receives direction from Director of Managed Care.
1. Monitors patients’ progress and clinical condition in order to ensure the effectiveness and appropriateness of in-patient services.
2. Ensures that all services are being delivered and meet the needs of the patient upon discharge.
3. Asses the physical, functional, social, psychological, environmental, and financial needs of patients. Identifies a cost-effective comprehensive plan to meet the patient and families’ service needs, and implements the plan.
4. Provides referrals to appropriate community resources and facilitates access and communication when multiple services are involved.
5. Monitors activities to ensure that services are actually being delivered and meets the needs of the client. Coordinates services in order to avoid duplication.
6. Assesses the patients’ formal and informal support systems.
7. Monitors patients’ progress toward goal achievement and periodically reassess changes in health status.
8. Acts as the patient advocate and helps identify and develop new community resources.
9. Assures accuracy of patient records and maintains patient confidentiality.
10. Performs other duties as assigned or required.
1. Principles of efficient and effective clinical care in the inpatient, outpatient, and home patient care settings.
2. Principles of chronic care including: health improvement, age-related conditions, partnership model of care, health behavior change facilitation and health promotion and coaching.
3. Principles of nursing diagnosis, care plan and evaluation of interventions.
4. Interpersonal skills using tact, patience and courtesy.
5. Principles of case management.
6. Skilled nursing homes, home health, and durable medical equipment utilization management criteria.
7. Pertinent Federal, State, and local laws, codes, and regulations regarding managed health care.
1. Coordinate assigned areas of responsibility with other departments and functional units.
2. Communicate clearly and concisely, both orally and in writing.
3. Establish and maintain cooperative and effective working relationships with others; use discretion in handling difficult persons.
4. Effectively respond to all situations/incidents using sound judgment and decision-making skills.
5. Read, interpret, apply and explain rules, regulations, policies and procedures.
6. Work independently with little direction; plan and organize work; meet schedules and timelines.
7. Maintain accurate and complete records.
8. Effectively provide patient education and demonstrations.
9. Help motivate and facilitate change in patient behavior and assess and evaluate patient understanding of the education provided.
10. Assess and evaluate patients’ responses to services provided, treatment, and medication.
11. Prioritize according to medical necessity, and work under time constraints.
Knowledgeable regarding current Medicare and health plan regulations. Requires 2 years experience, current CA RN license, and CPR certification. Strong clinical (ICU, ER, Urgent Care) background preferred as well as Case Management certification. A valid California driver’s license is required.
Office environment; exposure to computer screens, noise and electrical energy; extensive contact with faculty, staff, students and the public.
Essential functions require maintaining physical condition necessary walking, standing and sitting for extended periods of time. Must be able to travel to other organization locations.