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Role Description

This role involves providing management of patients transitioning from the inpatient care setting to home. Responsibilities include:

• Patient assessment and coordination of services in the immediate post-discharge phase
• Addressing care coordination, facilitation of referrals to providers, vendors, and community services
• Providing disease education, caregiver support, and self-care counseling
• Evaluating and modifying patient care plans based on post-discharge assessments
• Aligning patient/caregiver/family goals with identified problems/barriers and needs
• Reducing avoidable readmissions and emergency department visits
• Increasing patient and provider satisfaction

Qualifications

• Education as required for licensure
• 3 Years Recent hospital experience
• 3 Years Experience in Case Management/Utilization Management in Managed Care, preferably in a medical group or HMO setting
• 2 Years Recent pertinent clinical experience as defined by the CBA
• California Registered Nurse (RN) - CA Board of Registered Nursing - REQUIRED

Requirements

• Bachelor's Degree in Healthcare (preferred)
• UM, QM or CM preferred

Essential Functions

• Adhere to highest standards of performance through professional development
• Maintain current knowledge of applicable accreditation and regulatory statutes
• Keep individual in-service/performance records
• Participate in department/team process/quality improvement activities
• Have reliable means of transportation and willingness to travel to doctors' offices and facilities when requested
• Apply SCMG criteria for assessing patients in the immediate post-discharge phase
• Prioritize work list based on SCMG policy and procedure
• Conduct structured assessments to determine patient knowledge base and post-discharge needs
• Gather assessment information through multiple sources
• Accurately document assessment findings
• Coordinate patient care in the immediate post-discharge phase
• Facilitate communication and coordination of patient care among healthcare providers
• Collaborate with providers for timely delivery of goods and services
• Facilitate implementation/modification of plan of care in collaboration with patient/family
• Problem solve and explore options for care
• Identify members for possible case management intervention
• Educate patient/family, caregiver, and healthcare team members about their disease(s) and resources
• Accurately document interventions
• Apply effective interpersonal skills that are age appropriate
• Identify, report, and develop action plans for quality of care issues
• Assist and collaborate with the physician and quality department for monitoring non-adherence
• Observe policy and procedure for reporting quality of care issues
• Collaborate with departments for process improvement of quality of care
• Participate in quality improvement activities related to care and services
• Establish effective working relationships with internal and external customers
• Validate messages by clarifying expectations and verifying understanding
• Use special needs resources to communicate with patients/family
• Make sound decisions and handle situations not covered by instructions
• Participate in customer service performance improvement projects

Knowledge, Skills, and Abilities

• Broad based nursing knowledge in various healthcare settings
• Proficient knowledge of managed care, utilization management, and healthcare finances
• Exceptional communication, customer service, critical thinking, problem solving, and computer skills
• Ability to read, speak, and hear English clearly
• Bilingual communication preferred
• Working knowledge of computer programs (Excel, Word)