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Overview
Case Managers are licensed nursing professionals responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients. Major responsibilities include coordinating all facets of a patient's admission/discharge, performing utilization review activities, and ensuring optimum use of resources, service delivery, and compliance with external review agencies’ requirements.
Responsibilities
Coordination of Care – Complex case manager who manages each patient’s transition through the system and transfers accountability to the appropriate person upon entry into another clinical service or discharge.
Discharge Planning – Coordinates and facilitates timely implementation of discharge plans for assigned patients with complex needs in collaboration with other interdisciplinary team members and arranges follow‑up care as appropriate.
Utilization Review – Reviews prospectively, concurrently, and retrospectively all inpatients for appropriateness of admission, level of care, and determines appropriate length of stay; monitors patients’ length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and is appropriate for the patient’s clinical and psychosocial needs; plans and implements strategies to reduce length of stay and achieve positive patient outcomes.
Education/Consultation – Acts as an educational resource and provides consultation to patients, families, and hospital medical personnel regarding the discharge planning process and applicable regulatory requirements; educates staff on case management and provides specific information related to case types.
Lead Work – May lead the work of administrative/clinical support staff that assists with case management for an assigned patient caseload.
Patient Assessment/Plan of Care – Collaborates with physicians, social workers, nurses, and other interdisciplinary team members to assess, plan, and coordinate patient care needs; performs patient assessment and develops a plan of care to assure consistent, timely, and appropriate care is provided.
Quality Improvement – Participates in quality improvement activities by identifying opportunities for improvement in clinical outcomes, utilization of resources, and concurrent data collection.
Third‑Party Reimbursement – Collects, analyzes reports, and reviews patient information with third‑party payers to assure reimbursement for patient services/procedures; communicates with review organizations and payers to provide requested clinical and psychosocial information.
Education & Qualifications
Bachelor’s Degree from an accredited college or university (required).
Master’s Degree (preferred).
Experience
Three (3) years of progressively responsible and directly related work experience.
Knowledge, Skills, and Abilities
Ability to collect and record data, evaluate data and statistics, and maintain effective reporting systems.
Ability to develop and perform patient assessment and plan of care.
Ability to monitor and assure the patient’s access to the appropriate level of care and correct setting and services to meet the patient’s needs.
Ability to provide age‑appropriate assessments, interpretation of data, and delivery of interventions.
Ability to provide appropriate patient care and clinical information when patients are admitted, referred, transferred, or discharged.
Ability to remain knowledgeable regarding available treatments and services.
Ability to resolve conflicts and/or negotiate with others to achieve positive results.
Ability to understand, interpret and apply complex federal and state hospital compliance laws, rules, regulations and guidelines.
Ability to work effectively with individuals at all levels of the organization.
Knowledge of available patient services and treatment.
Knowledge of current theories, principles, practices, standards, emerging technologies, techniques and approaches in the nursing profession, and the health care system.
Knowledge of evaluation and assessment techniques.
Knowledge of financial processes of various private and public funding sources for health care services/procedures.
Knowledge of hospital operations, organization, systems and procedures and laws and regulations pertaining to the operation of hospitals in California.
Knowledge of medical terminology and related levels of care and treatment.
Knowledge of the full continuum of care available to patients, interrelationships of the care components, and their effective integration.
Knowledge of the models of case management, including the principles and practices of discharge planning, utilization review, and quality assurance/improvement.
Knowledge of the variables that affect the processes and outcomes of patient health care.
Licenses and Certifications
Nursing (RN) – Registered Nurse – State licensure and/or Compact state licensure required.
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C‑I‑CARE standards for all patients, families and towards each other.
Equal Opportunity Employer: Stanford Health Care strongly values diversity and is committed to equal opportunity and non‑discrimination in all of its policies and practices. Applicants of all genders, racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Base Pay Scale: Generally starting at $74.73 – $99.04 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.