JOB DESCRIPTION CCSC RN Case Manager The Center for Elders' Independence is a PACE (Program of All-Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, and promoting autonomy, quality of life and the ability of individuals to live in their communities. The Position: The Coordination of Care Service Center RN Case Manager is responsible for monitoring and facilitating appropriate resource management of CEI participants in Hospital and SNF settings and for collaboration with others to assure optimal participant disposition. Understands placement options, makes recommendations for alternative levels of care and is responsible for smooth transition and discharge from Hospital and Emergency Department.
DUTIES AND RESPONSIBLITIES
- Assesses and evaluates care provided to CEI members in non-CEI settings.
- Develops and evaluates appropriate treatment plans in conjunction with provider.
- Assures appropriate, timely review and authorization for hospital or SNF stay.
- Acts as CEI single point of contact and liaison for hospital during business hours.
- Reviews clinical information and collaborates with internal and external physicians and other providers for optimal and timely disposition.
- Communicates frequently with CEI physician and IDT as needed to assure and execute optimal discharge and continuity of care plan.
- Develops collaborative, productive relationships with hospital and SNF health care providers to achieve optimal participant care and outcomes across the continuum.
- Knowledgeable regarding contracts and CEI benefit coverage.
- Able to identify appropriate level of care for SNF placement, providing guidance for IDT.
- Collaborates with CEI physician to oversee care of CEI participants at SNF's.
- Monitor's and documents participants' care according to established skilled care guidelines.
- Assists with development, review and revision of departmental policy and procedures which support positive outcomes and organizational objectives.
- Open to best practice model suggestions.
- Offers input and complies with department standards of care and practice as well as quality improvement activities.
- Investigates participant concerns as identified and offers satisfactory resolution regarding case management role.
- Consistently complies with organizational Code of Conduct by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state, and local laws and regulations, accreditation and license requirements.
- Models ethical behavior; adheres to organizational policies and guidelines; maintains confidences; admits mistakes; conducts work with honesty; shows consistency in words and actions and follows through on commitments.
- Demonstrates on openness to creative and innovative approaches to providing service.
- Checks for new hospital admissions and ED visits via Direct Line Tele-Response fax transmission.
- Recording ED notifications and e-mailing messages to Clinic IDT.
- Locating contracted SNF, obtaining physician approval/authorization for participants who require short term placement.
- Requests hospital documentation for hospital stays and ED visits are reviewed by the provider.
- Ensuring status updates are transmitted via e-mail to all relevant parties as they occur for any participant going to or being discharged from the ED, hospital, and/or SNF.
- Performs other related duties as required or assigned to support the efficient operation of the department and organization.
QUALIFICATIONS
- BSN in Nursing required from accredited school of nursing.
- CCM Preferred.
- Current California Nursing RN license required.
- CPR certificate required.
- 3-5 years of Case Management experience required
- PACE work experience preferred.
- Understanding of Nurse Practice Act and all other local, state, and federal regulations.
- Demonstrated strong interpersonal communication skills.
- Experience working with electronic medical records and intermediate/advanced computer skills (Microsoft Office Suite) required.
- Ability to perform duties in heavy workload, fluctuating environment.