Registered Nurse Case Manager (RN)

San Ramon Regional Medical Center began serving residents of the San Ramon Valley and its surrounding communities in 1990. Located on a hillside overlooking the valley, we are a 123-bed, acute-care hospital, primary stroke center, and a cardiac heart surgery hospital. San Ramon Regional Medical Center provides comprehensive inpatient and outpatient services. Personalized service and a patient-centered philosophy are distinctive qualities of our facility.

We offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including employee assistance program (EAP)
• Time away from work programs for paid time off, long- and short-term plan coverage
• Savings and retirement  including a 401(k) Plan with a 50% match up to 6% of pay, employee stock purchase plan, flexible spending accounts, retirement readiness tools, rollover support, and financial well-being counseling
• Education support through tuition assistance, student loan assistance, certification support, and online educational program
• Additional benefits  life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and employee discount program
• Registered nurses – Retirement medical benefit account (RMBA) – 2% of annual eligible income set aside in accordance with program guidelines
• Benefits may vary by location and role 

SUMMARY:

The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including:

•   Utilization Management supporting medical necessity and denial prevention
•   Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
•   Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
•   Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
•   Education provided to physicians, patients, families and caregivers

The individual’s responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) care coordination, c) transition planning assessment and reassessment, d) implementation or oversight of implementation of the transition plan, e) leading and facilitating multi-disciplinary patient care conferences, f) managing concurrent disputes, g) making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services, i) communicating with patients and families about the plan of care, j) collaborating with physicians, office staff and ancillary departments, k) leading and facilitating Complex Case Review, l) assuring patient education is completed to support post-acute needs , m) timely complete and concise documentation in Case Management system, n ) maintenance of accurate patient demographic and insurance information, o) identification and documentation of potentially avoidable days, p) identification and reporting over and underutilization, q) and other duties as assigned.

PRIMARY INFORMATION, TOOLS AND SYSTEMS USED
•   Patient data – hospital admission, discharge, transfer system
•   Healthcare staff documentation related to patient care
•   Regulatory and payor requirements
•   Allscripts ® Care Management System
•   McKesson Care Enhance Review Manager (CERMe) InterQual system
•   Clinical data interface and secure faxing
•   Patient Medical Record including Cerner and HPF
•   Hospital specific Clinical Software

Utilization Management

• Balances clinical and financial requirements and resources in advocating for patient needs with judicious resource management
• Assures the patient is in the appropriate status and level of care based on Medical Necessity process and submits case for Secondary Physician review per Tenet policy
• Ensures timely communication of clini