RN Case Manager Per Diem Rotate

Twin Cities Community Hospital, a 122-bed acute care hospital, has been caring for the communities of Northern San Luis Obispo County since 1977. With a medical staff of more than 200 physicians and 400 caregivers and support staff, the hospital specializes in emergency care, obstetrics, orthopedics, digestive disorders, wound care and a broad array of medical, surgical and outpatient services. Twin Cities Community Hospital earned The Joint Commission’s Gold Seal of Approval® with distinction for its knee replacement program and was the first hospital in San Luis Obispo County to earn the LGBTQ Healthcare Equality “Leader” designation from the Human Rights Campaign Foundation. In addition, the hospital is recognized as a Blue Distinction Center+ for Knee and Hip Replacement Surgery. Baby-Friendly USA designated Twin Cities Community Hospital as an internationally recognized Baby-Friendly birth facility. The hospital also reports one of the lowest Cesarean section rates in the State of California. Twin Cities has earned an “A” from the Leapfrog Hospital Safety Grade. 

• 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 

A Community Built on Care (2:30) https://www.youtube.com/watch?v=Z8Z2BB8IbZ0&t=18s 

Job 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.

Qualifications

EDUCATION / TRAINING / EXPERIENCE:

Minimum:

Graduate of a nursing program with at least 5 years experience in an acute care setting. Experience in utilization review, discharge planning and/or home health preferred. Recent experience in acute care hospital case management pref