Case Manager II-Post Discharge -SCMG Integrated Care Mgmnt - System Services-Remote (San Diego County only) - FT - 8hr Days

Hours:

Shift Start Time:

8 AM

Shift End Time:

4:30 PM

AWS Hours Requirement:

8/80 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$69.070 - $75.080 - $96.480

 

The stated pay scale reflects the range as defined by the collective bargaining agreement between Sharp HealthCare and Sharp Professional Nurses Network, United Nurses Associations of California/Union of Health Care Professionals, NUHHCE, AFSME, AFL-CIO.  Placement within the range is based on years of RN experience.

What You Will Do
To provide management of patients transitioning from the inpatient care setting to home. Involves patient assessment and coordination of services in the immediate post discharge phase. Addresses care coordination, facilitation of referrals to providers, vendors, and community services, disease education, caregiver support and self-care counseling. Responsible for evaluation and if necessary modification of patient care plan based on post discharge assessment addressing medical/psychosocial status changes and facilitating the patient/caregiver/family goals to align with patient's new identified problems/barriers and needs. Results in decrease in avoidable readmissions and emergency department visits as well as increased patient and provider satisfaction.

Required Qualifications

• Education as required for licensure
• 3 Years Recent hospital experience
• 3 Years Experience in Case Management/ Utilization Management in Managed Care, preferably in a medical group or HMO setting
• 2 Years Recent pertinent clinical experience as defined by the CBA
• California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED

Preferred Qualifications

• Bachelor's Degree Healthcare

Other Qualification Requirements

• UM, QM or CM preferred.

Essential Functions

• Adheres to highest standards of performance by keeping skills and competencies up to date through professional development, identifying gaps in skills and competencies and seeking the knowledge and training necessary to perform at and above standards.
  Keeps current knowledge and understanding of applicable accreditation and regulatory statutes related to health care, managed care, case management practice.
  Maintain individual in-service/performance records.
  Attends and actively participates in department/team process/quality improvement activities.
  Have reliable means of transportation and willing to travel to Doctors offices and Facilities when requested.
• Applies SCMG criteria for assessing patients in the immediate post discharge phase
  Prioritizes work list based on SCMG policy and procedure.
  Conducts structured assessment to determine patient knowledge base, adherence with the medical care plan and post discharge needs and barriers.
  Assessment information is gathered through multiple sources: telephonic patient/patient designee interview, review of medical records, collaboration with primary care physician, specialists and other health care providers.
  Assessment should include the following components: receipt and understanding of discharge instructions; follow up appointments; medications; DME; home health services; other ancillary services; psychosocial issues and patient compliance.
  Accurate documentation of assessment findings.
• Coordinates patient care in the immediate post discharge phase
  Demonstrates appropriate and timely maintenance of workload of assigned patients based on SCMG policy & procedure.
  Facilitates communication and coordination of patient care in the immediate post discharge phase among the healthcare providers.
  Collaborates with providers for timely delivery of goods and services by contracted and non-contracted vendors.
  Facilitates implementation/modification of plan of care in collaboration with patient/family, primary care physician, and healthcare providers to maximize quality and cost-effective outcomes and reduce avoidable ED visits and readmissions.
  Problem solves, exploring options to care and determining coverage benefits and alternative plan when necessary to achieve desired outcomes.
  Identifies members for possible case management intervention when there is: lack of established or ineffective treatment plan/specific goals, non-adherence treatment/medications, permanent or temporary alterations in function, medical/psychological/functional complications, lack of resolution in meeting health care needs, lack of education of disease course/process,