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RN Case Manager - PRN - Days & Weekends
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RN Case Manager - PRN - Days & Weekends

Job Description

This position will also enhance the continuity of care and cost effectively by integrating the functions of case management, utilization management and discharge planning.

A. Performs and/or is able to perform all the functional responsibilities of the Care Management team. (E)
B. Supervises the human resource functions for the selection, orientation, continued follow-up, support and performance appraisals of staff to ensure that all related actions are managed in accordance with established hospital and departmental policies. (E)
C. Monitors outcomes of associates on monthly basis by report card and meetings. (E)
D. Assist in the development and implementation of a systematic approach to monitor the effectiveness of the Care Management Program including resolution strategies. (E)
E. Maintain current policies and procedure.  Provides education on P&P to associates. (E)
F. Coordinates the delivery of patient care within Care Management purview and ensures compliance with established hospital and regulating standards.  Facilitates discharge planning processed in conjunction with other disciplines. (E)
G. Monitor Payer Initiatives: Provides information to the medical and hospital staff regarding current reimbursement, review regulations and guidelines, and processing of denials. (E)
H. Maintains a working relationship with community agencies and external reviewing and paying agencies including the professional review organization (PRO), Medicaid, CMS, private review organizations and third party payers. (E)
I. Monitor compliance of Avoidable Days of the CM associates and prepare report.  Issue any letters needed to be given to physicians, departments, etc. (E)
J. Monitor compliance of Readmits of the CM associates and prepare report.  Notify Quality Management of any issues dealing with readmits to CHRISTUS Santa Rosa. (E)
K. Monitor schedules, PTO, and Time and Attendance policy to Associates in the Care Management Department. (E)
L. Monitor Care Management Associate education requirements and compliance for the Hospital’s annual requirement through Healthstream. (E)
M. Guest Relations/Communications; Demonstrates positive role modeling of customer relations (customer include patient, physicians, other health care team members, and payers, etc.)  Use AIDET and KWKT appropriately. (E)
N. Translates strategies into action steps; clearly assigns responsibility for decisions and tasks; sets clear objectives; monitors progress and achieves results. (E)
O. Demonstrates the confidence, drive and ability to face and overcome challenges and obstacles to achieve organizational goals. (E)
P. Management of Denial Process; collaborate with Care Management Team to decrease the number of denials.  Provide education and mentoring to team on denial issues.  Will report to the denial meeting and perform any duties that may overturn denials.  Bring knowledge to the denial meeting base on clinical experience. (E)
Q. Demonstrates competence to perform assigned responsibilities in a manner that meets the population-specific and developmental needs of members served by the department. (E)
R. Appropriately adapts assigned assessment, treatment, and/or service methods to accommodate the unique physical, psychosocial, cultural, age specific and other developmental needs of each member served. (E)
S. Demonstrates adherence to the CORE values of Santa Rosa Health Care. (E)
T. Performs other duties as assigned. (M)

Job Requirements

Qualifications:

A. EDUCATION:
1. Completion of a formal school of nursing is required. 
2. BSN preferred.

B. EXPERIENCE:
1. A minimum of five (5) years in clinical practice for population to be served is required. 
2. Case Management/Utilization management and discharge planning experience preferred.




Requisition Number: 30011137

Job Snapshot

Employment Type Part-Time
Job Type Health Care
Education 4 Year Degree
Experience Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
Job ID 30011137
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RN Case Manager - PRN - Days & Weekends


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