BA/BS or equivalent combination of education and experience required. BSN strongly preferred. Most successfully complete the Case Management Orientation Program within ninety days from date of hire. Current California RN Licensure required. •National certification in Case Management (ACM, CCM) and Supervisory training desired.
Experience: • 3-5 years of direct patient care or patient education in an inpatient, outpatient, ambulatory or home health setting • Hospital or ambulatory case management or disease management • Team leadership in a clinical nursing environment • Proficiency and clinical work within the areas of cardiac telemetry, treatment of arrhythmias Previous ICU experience a plus • Strong familiarity with the etiology and current therapeutic modalities in the areas of cardiac, pulmonary and diabetic care • Experience with electronic health records and computerized patient care systems – Epic experience desirable • Previous clinical experience in more than one level of care, i.e.: Intensive Care, Med-Surg, ED, Home Health, etc., strongly preferred. • Previous case management experience is preferred. • Experience using InterQual is strongly preferred. • Broad acute clinical background (experience in more than one population and level of care) strongly preferred.
Knowledge/Abilities: • General knowledge of illnesses, current treatments and their physical and psychosocial sequelae. • Specific knowledge in the areas of cardiac diseases, COPD, congestive heart failure, diabetes, asthma, hyperlipidemia and hypertension • Applicable laws and regulations regarding government and commercial insurance benefits including basic knowledge of governmental (Medicare, Medi-Cal, etc.) healthcare reimbursement systems is required, as well as advanced knowledge of healthcare reimbursement systems: HMO, PPO, Capitated agreements, PPS, etc., is preferred. • General knowledge of coding and DRG assignment process is preferred. • Motivational Interviewing or Shared Decision Making techniques • Available health care and community resources appropriate for populations served • Individual and family development over the life span and the influence of cultural and spiritual values in health care • Data collection techniques and methods of analyzing and reporting data • Ability to use clinical knowledge to identify potential quality of care issues, delays in service, and post-acute care needs required. • Intermediate level computer skills are required. • General typing skills (35 WPM) required.
Special Skills/Equipment: • Must be able to effectively communicate with, and promote cooperation between, multiple people including: patients and their families; physicians, nurses, social workers, etc. • Able to orchestrate successful, complex discharge plans. • Must be able to develop an organized work plan in a high-volume environment with rapidly changing priorities. • Ability to work independently with a minimum of direction, anticipate and organize workflow, prioritize and follow through on responsibilities • Must have strong clinical assessment and critical thinking skills necessary to provide utilization review/discharge planning services appropriate to patients with complex medical, emotional and social needs. • Interpersonal relationship development, problem-solving, conflict resolution, presentation, time management, positive personal influence and negotiation skills • Ability to work respectfully and creatively with clients of diverse functional abilities, social, economic, and cultural backgrounds to support both client autonomy and client safety • Demonstrated skills in motivating, mentoring, coaching and redirecting clients in order to achieve compliance with various necessary medical, social and functional interventions • Leadership skills to delegate provide direction/guidance to staff and hold others accountable • Strong clinical assessment and critical thinking skills necessary to provide care-planning and medication adjustments based on algorithms appropriate to patients with complex medical, emotional and social needs • Strong attention to detail and accuracy • Must have the ability to work in a high-volume caseload environment and deal effectively with rapidly changing priorities • A demonstrated ability to work constructively with a broad spectrum of health care professionals • Assertive and creative in problem solving, system planning and management • Advanced computer skills are required. Ability to work with databases, Microsoft Suite and EPIC • Must have the ability to create and communicate clearly via written and oral communication using SBAR