The individual's responsibilities will include, but not be limited to the following activities: • a) Medical necessity screening • b) Care coordination • c) Discharge planning • d) Facilitating multi-disciplinary patient care conferences • e) Managing concurrent disputes • f) Making the appropriate referrals to other departments (e.g., nutrition, PT/OT/ST) • g) Referring complex social issues to Social Service • h) Communicating with patients and their families about the plan of care • i) Collaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy) • j) Participating in weekly Complex Case Review • k) Arranging for post-discharge patient education • l) Clear, complete and concise documentation in eCCM • m) Maintaining accuracy of patient demographic and insurance information • n) Identifying and documenting potentially avoidable days • o) Identifying and reporting over and under utilization • and other duties as assigned.
• Current California RN license • Minimum 2 years of acute case management experience • Minimum 5 years bedside experience or 10 years in the relevant clinical specialty (e.g., case manager for pediatrics patients should have pediatric nursing experience).