SLH Case Manager RN
Company: Alameda Health System
Location: San Leandro
Posted on: January 26, 2023
Summary Job Summary: The SLH Case Manager RN is responsible for
providing comprehensive case management services to clients
identified with complex health conditions and social challenges
that are at risk for health status decline. The goals and focus of
these service efforts are to provide timely delivery of intensive
case management servicesduring the transitional period beginning
with hospitalization and culminating with integration back into the
community setting to prevent further health deterioration and
reduce the need for more costly services such as acute care
hospitalization and to develop self-management skills that improve
his or her long-term health status. Performs related duties as
required. DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are
the duties performed by employees in this classification, however,
employees may perform other related duties at an equivalent level.
Not all duties listed are necessarily performed by each individual
in the classification. 1. - Conducts discharge planning assessments
in a timely and complete manner. Assessments and interventions;
considers the age and cultural or religious influences of the
2. - Coordinates disposition of Medi-Cal, self-pay, and out-of-plan
patients, including working with physician to determine readiness
for transfer, securing placement and completing TAR and other
documentation; contacts with payers conducting phone reviews and
initiates denial appeals as needed.
3. - Encourages patients to develop realistic plans. Makes direct
contact with or refers patient/family to appropriate community
resources. Maintains knowledge of currently available resources in
4. - Guides the patient in understanding the nature of his illness;
confers with patients and their families to prepare for the
patients' discharge. 5. - Provides community resource education and
coaching, focusing on individual client self-management principles.
This includes preparing for provider visits and supporting the
disease management principles introduced by the nursing team.
6. - Reassesses the client's condition when changes occur and
revises the care plan as appropriate. Coordinates and arranges for
needed services with appropriate local resources. Serves as client
advocate to secure services and financial benefits.
7. - Reviews all the patients in his/her caseload in the following
areas; admission criteria for medical necessity and appropriateness
of care; continued stay criteria for medical necessity and
appropriateness of care; resource Management issues; other issues
including concerns involving under/over utilization, avoidable days
and quality issues. Coordinate daily with interdisciplinary team in
transitioning patient throughout hospital stay; provides discharge
planning services, working with patient/family and receiving multi
disciplinary input, so that an appropriate plan is developed
enabling a patient to go home, or facilitates the relocation of the
patients to another setting.
8. - Serves as a mentor and educator to the organization's health
care team assisting with care coordination, training, and quality
improvement activities; provides staff education regarding Advance
Directives and POLST when requested.
9. - Understands insurance, governmental, and accrediting agency
standards to determine criteria concerning admissions, treatment,
and length of stay of patients. Takes appropriate action when cases
do not meet criteria - coordinates denials with the attending
physician, and the UR physician advisor. Prepares case reports;
documents treatment plan, progress notes and discharge summary
related information as required by Medicare, MediCal, Title 22 and
other mandated regulations according to Department standards. Keeps
required statistics. Qualifications:
Education: Associates's degree in a related field. Bachelor's
Minimum Experience: Two years related in acute care facility and/or
utilization review training.
Minimum Experience: Varied clinical experience or experience in
case management/community health preferred.
Preferred Licenses/Certification: Public Health Nurse, Case
Management, or Home Health.
Required Licenses/Certifications: BLS - Basic Life Support
Certification - issued by AHA-American Heart Association.
Required Licenses/Certifications: Valid license to practice as a
Registered Nurse in the State of California. San Leandro
SLH Social Services
Keywords: Alameda Health System, San Leandro , SLH Case Manager RN, Healthcare , San Leandro, California
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