Sutter Health ED RN Case Manager , Case Management (FT) in Burlingame, California
The Emergency Department (ED) RN Case Manager initiates admission screening in the ED to support that the right care is provided at the right place and at the right time. Using InterQual criteria to evaluate the appropriateness of admission, level of care, and readiness for disposition from the ED, the ED CM facilitates movement of patients through the ED; conducts timely screening reviews, collaborates with the ED physician and nursing staff to identify patient’s admission status or potential case management needs, proactively assesses post-care needs, coordinates care with the treatment team, family and others as necessary. Actively works to prevent unnecessary (re)admissions by coordinating and finding resources. The ED Case Manager reports to Manager or Supervisor of Care Coordination. The ED Case Manager has frequent contact with patients, families, nurses, physicians, payers and review agencies, contracted providers and community resources.
The Case Management Department at MPHS embraces the Scope of Services adopted by the American Case Management Association which states: “Case Management in Hospital and Health Care Systems is a collaborative practice model including patients, nurses, social workers, physicians and other practitioners, caregivers and the community. The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health access to care and appropriate utilization of resources, balanced with the patient’s right to self-determination.” Knowledge of available health care and community resources; can effectively identify options for discharge from the ED utilizing community resources. A broad knowledge base of health care delivery and case management within a managed care environment. Comprehensive knowledge of Utilization Review, levels of care, and observation status.
BS in one of following: Nursing or Health Administration is required.
National Certification in Case Management (ACM, ANA, RN-BC Case Management) within 24 months of hire required.
CA RN license required.
MS in Nursing, Case management or related field desired.
Minimum of three (3) years in acute medical/surgical/ED or critical care nursing area required. Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED or critical care area may be considered for employment at director's discretion.
Previous ED nursing and/or ED Case Management experience preferred.
Experience utilizing electronic InteQrual or other standardized criteria strongly preferred.
Experience with clinical assessment for patient with complex medical, emotional and social needs.
Experience using an electronic medical record system.
Experience and knowledge with MIDAS preferred.
Excellent interpersonal communication and negotiation skills.
A broad knowledge base of health care delivery and case management within a managed care environment.
Comprehensive knowledge of Utilization Review, levels of care and observation status.
Some awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS preferred.
Post-acute levels of care such as Home Health, Hospice, AIM and Palliative Care, SNF, B&C, Assisted Living, Sub-acute, Acute rehab.
General knowledge of DRG assignment process preferred.
Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.
Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
Demonstrates commitment to service excellence in all patient, family and employee interactions and in performing all job responsibilities.
Functions in a manner to promote quality patient care and assure a positive patient experience.
Excellent verbal and written communication skills.
Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
Intermediate computer skills.
Ability to promote teamwork and to effectively function in teams.
Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.
Primary Location: California, Peninsula/South Bay and Santa Cruz, Burlingame
Organization: Mills-Peninsula Health Services
Employee Status: Regular
Position Status: Non-Exempt
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Monday-Friday
Weekend Requirements: Other
Schedule: Full Time
Hrs Per 2wk Pay Period: 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.