Case Management Nurse

  • NATIVIDAD
  • Salinas, California
  • Oct 31, 2021
Full Time Public Health
  • Salary: $9,518.77 - $12,993.59 Monthly USD

Job Description

Position Description
Application materials will be reviewed in an ongoing basis until positions are filled. Please allow up to (2) two weeks for processing of application materials. (Postmarks and faxes not accepted.) The eligible list established by this recruitment maybe used to fill current and future permanent or temporary vacancies as they arise (Natividad offers up to a $5,00.00 sign-on bonus to candidates hired into a permanent position). Exam# 21/52A33/03CR.

POSITION DESCRIPTION

Natividad is currently seeking to fill one (1) permanent, full-time Case Management Nurse position in the Utilization Management Department. Under direction, this incumbent performs care management utilization review and/or patient discharge/transfer care coordination on assigned units; identifies potential or existing utilization review and patient discharge/transfer planning problems and facilitates resolutions; and performs other related work as required.
Examples of Duties

SIGNIFICANT RESPONSIBILITIES OF THE POSITION

  • Actively participates on the Patient Care Team to ensure all care providers are effectively managing transitions of care
  • Assesses, plans, evaluates, and coordinates management of patient care, including discharge planning and utilization needs, in a timely manner
  • Identifies discharge needs, determines the appropriate level of care that the patient can transition to, coordinates planning, and problem solves continuity issues to ensure continuum of patient care and prevent patient readmission to the hospital
  • Performs utilization review and payor notification in a timely manner
  • Accurately and completely documents clinical reviews in accordance with documentation standards, policies and procedures, and/or guidelines
  • Provides consultation to professional staff and physicians on level-of-care determinations, CMS regulations, payor-specific guidelines, patient stay options, psychosocial concerns, risk management, and ethical issues
  • Educates the patient, patient's family, and other members regarding financial out-of-pocket costs and patient's financial responsibility
  • Educates hospital ambulatory services leadership and staff to current care management practices, patient coordination issues, and unit specific trends to ensure smooth transitions of care and effective complex case management
  • Identifies patients with chronic conditions and gaps in clinical care/services
  • Implements evidence-based care and chronic disease protocols and guidelines
  • Identifies targeted population within practice site(s) per clinical claims data
  • Coordinates with the multidisciplinary team in meeting patient care goals
  • Ensures all appropriate clinical information is provided to outside agencies
  • Takes responsibility to identify and eliminate barriers to effective patient-stay management and promote improvements in work processes within departments, hospital, clinics, and the community
  • Refers quality issues and poor utilization of services to the appropriate sources
  • Establishes community partnerships to optimize the patient experience and help facilitate positive patient satisfaction outcomes.

Examples of Experience/Education/Training

MINIMUM QUALIFICATIONS
License: Possession of a valid Registered Nurse (RN) issued by the State of California or the ability to obtain prior to start. (Please ensure that the name on your license/certification either matches the name on your application or is indicated somewhere on your application, as all licenses/certifications will be verified via primary source) .

A combination of experience, education, and/or training which substantially demonstrates the following knowledge, skills and abilities:

Thorough knowledge of:
  • Community resources, payer sources, and means by which to manage them in order to achieve the required continuum of care/services after discharge
  • Hospital Ambulatory Services routines, organization, and dynamic interrelationships
  • Medical terminology
  • Common disease stages, sequences, progression, processes, and resulting treatment plans found frequently in acute care and/or extended care settings
  • Follow-up care, equipment, and patient needs upon/after discharge
  • Principles, practices, and theories of acute and/or ambulatory-care management, utilization review, and discharge planning
  • Joint Commission standards and requirements pertaining to utilization review and discharge planning
  • Medicare regulations, reporting requirements, review practices, and funding of outpatient services
  • Medi-Cal regulations addressing prior authorization, concurrent review, reimbursement, and funding of outpatient services
  • Chronic conditions, evidence-based guidelines, prevention, wellness, health-risk assessments, and patient education
  • Development, education, implementation, and evaluation of population health programs.
Skill and Ability to:
  • Develop a care plan that addresses patient health needs in a cost-effective manner
  • Complete an expanded assessment of patient and family capabilities and needs
  • Build consensus, resolve conflicts, and coordinate interdisciplinary team efforts for care management
  • Analyze complex data and trends, recognize causal relationships, and derive conclusions
  • Provide clinical consultation and perform bedside nursing
  • Compile and interpret data and prepare clear, concise and accurate reports
  • Communicate tactfully and effectively, both orally and in writing, at a level necessary to perform the responsibilities and duties of the position
  • Exercise sound judgment while continuously prioritizing work assignments and providing counsel and/or advice to patients, their families, outside agencies, and hospital personnel
  • Maintain cooperative relationships with coworkers, the public, and all others contacted through the course of work
  • Utilize common computer software applications and hospital-specific programs.

A typical way to acquire the knowledge, skills and abilities listed above is:
Any combination of training, education, and/or experience which provides the knowledge, skills and abilities, and required conditions of employment listed above is qualifying. An example of a way these requirements might be acquired is:

Education: Completion of an accredited nursing program with a valid CA Registered Nurse License
AND
Experience: One (1) year of experience performing utilization review and/or discharge planning duties in an acute-care hospital setting
OR
Three (3) years' experience as a registered nurse in an acute care hospital setting on a Medical/Surgical unit, with at least one (1) year in a charge nurse role.
Additional Information

CONDITIONS OF EMPLOYMENT
  • Natividad requires that all incumbents pass a pre-employment physical/medical assessment.
  • Natividad will conduct a thorough background and reference check process which includes a Department of Justice fingerprint check.
  • Employees who drive on County business to carry out job related duties must possess a valid CA Driver License for the class vehicle driven.
  • Employees must have and show their original Social Security Card and a valid CA Driver License or CA State ID prior to the first day of work.
  • Incumbents may be required to work all shifts, including weekends and holidays;
  • Incumbents may be required to work with potentially hazardous and infectious substances.

**REQUIRED APPLICATION MATERIALS AND SCREENING PROCESS**

APPLICATION SUBMISSION: A completed Monterey County Application may be obtained from and submitted to the Natividad Human Resources Office, 1441 Constitution Blvd., Bldg. 300, Salinas, CA. 93906, or On-line applications may be submitted at www.natividad.com ; resume and license and/or certifications (if applicable) may be attached to your online application or emailed separately to: GarciadL@natividad.com . Resumes will be accepted in addition to, but not in lieu of the required application materials. For more information or to obtain regular paper application materials please contact the Natividad HR, 1441 Constitution Blvd.,(831) 783-2700, M - F, 7:30 a.m.- 5:00p.m.

QUALIFICATIONS APPRAISAL: : All licenses/certificates will be verified via primary source. Completed application materials will be competitively evaluated. Please note: The initial screening for this position uses ONLY the applicant's answers to the Supplemental Questions. Screeners (who are Subject Matter Experts) are not given the application and/or resumes at this point in the process. Therefore, your answers to the Supplemental Questions are critical. The best-qualified applicants will be invited to participate further in the process.

QUALIFICATIONS ASSESSMENT: To further assess applicants' possessions of required qualifications, this process may include an oral examination, pre-exam exercise, performance exam, or physical ability exam.

ELIGIBLE LIST: Applicants successful in the Qualifications Assessment process will be placed on an eligible list for possible final selection interview. This eligible list will be used to fill current and future vacancies.

SPECIAL NOTES
  • If you believe you possess a disability that would require test accommodation, please contact the HR Analyst for Natividad at (831) 783-2711.
  • Employment is contingent upon acceptable documentation verifying identity and authorization for employment in the United States.
  • If you are hired into this classification in a temporary position you will not be eligible for the benefits.
Natividad offers up to a $5,00.00 sign-on bonus to candidates hired into a permanent position.

Benefits:

http://www.co.monterey.ca.us/government/departments-a-h/human-resources/human-resources/benefits/benefit-summary-sheet

Job Address

Salinas, California United States View Map