Nurse Case Manager Acute Care

Overview

• Deliver exceptional case management for acute care patients, ensuring seamless transitions and optimal health outcomes.
• Collaborate with interdisciplinary teams to design and implement personalized care plans addressing diverse patient needs.
• Conduct comprehensive assessments to evaluate clinical, psychosocial, and financial aspects of patient care.
• Ensure compliance with healthcare regulations and standards for patient care and transitions.
• Facilitate effective communication among patients, families, and healthcare professionals to support care coordination.
• Monitor patient progress and adjust care plans to achieve desired health outcomes.
• Coordinate discharge planning by liaising with community health resources and providers.
• Serve as a resource for staff and physicians regarding care management protocols and best practices.

Key Responsibilities & Duties

• Conduct timely admission reviews and assessments to establish effective care plans.
• Collaborate with emergency department coordinators to ensure smooth patient transitions.
• Develop and implement care plans addressing clinical milestones and patient goals.
• Ensure efficient resource utilization and adherence to regulatory guidelines.
• Educate physicians and staff on admission status and regulatory requirements.
• Monitor clinical outcomes and address quality and efficiency concerns proactively.
• Coordinate safe discharge plans and follow-up care for patients.
• Maintain effective communication with interdisciplinary teams and patient families to ensure cohesive care delivery.

Job Requirements

• Bachelor of Science in Nursing (BSN) or Master’s degree in Nursing required.
• Active California Registered Nurse (RN) licensure mandatory; Case Management certification preferred.
• Minimum of two years of experience in acute care or case management settings.
• Proficiency in utilizing medical necessity criteria, including Interqual guidelines.
• Strong clinical and critical thinking skills to establish and execute complex care plans.
• Knowledge of healthcare delivery systems and payer prior approval requirements.
• Effective communication skills for interacting with patients, families, and healthcare teams.
• Ability to analyze situations accurately and take effective action to resolve challenges.