Clinical Case Manager - Diabetes - SCV - PT .8 - Days

Hours:

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Weekend Requirements:

On-Call Required:

Hourly Pay Range (Minimum - Midpoint - Maximum):

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. 

What You Will Do
Responsible for coordination of services utilizing a multidisciplinary plan to ensure the effective and efficient consumption of available health care resources while maintaining quality and cost effective care for patients throughout the continuum. The Clinical Case Manager facilitates and coordinates services with health care professionals and monitors the patient's progress towards the achievement of quality and cost outcomes. The Clinical Case Manager is responsible for accurately completing a patient assessment and developing the patient's discharge plan. The Clinical Case Manager is an expert clinical practitioner who participates in the development and evaluation of clinical guidelines and standards of care. The Clinical Case Manager collects data and assists in trending and analysis of aggregate service line data to be used in identifying best practices and performance improvement opportunities. The Clinical Case Manager is self directed and motivated, exhibiting independence in function and judgement.

Required Qualifications

• Bachelor's Degree in Nursing or related health care degree.
• 3 Years Acute care clinical experience in area of specialty.
• California Registered Nurse (RN) - CA Board of Registered Nursing
• AHA Basic Life Support for Healthcare Professional (AHA BLS Healthcare) - American Heart Association

Other Qualification Requirements

• Working toward case management certification required.

Essential Functions

• Assess treatment plan
  Assesses the patient's physical and psychosocial status, diagnosis, and treatment plan to ensure appropriateness.
  Sets patient-centered goals in collaboration with the healthcare team and makes plan modification when necessary.
  Identifies patient risk factors/status and refers to appropriate resources for inpatient management and post-acute discharge continuum management.
  In collaboration with health team members, implements, monitors and revises tools, protocols, clinical pathways, guidelines and outcome data to develop a research based multidisciplinary care process.
  Intervenes when variances occur in a patient's individualized treatment plan.
  Monitors and evaluates short and long-term patient responses to therapeutic interventions, maintaining interdepartmental follow up as necessary.
  Assesses the patient and family needs for education and information of healthcare resources, insurance, and discharge planning. Collaborates with interdisciplinary team to coordinate patient care plan, inpatient education, timely discharge, appropriate placement and provide for post-acute discharge resources and services.
  Identifies patients who would benefit from Home Care Services (Home Health, Hospice, or Home Infusion Therapy). Assesses and plans for Home Care referrals.
  Facilitates performance improvements by evaluating patient care processes that may include standards, protocols, pathways, policies and procedures, and documentation to ensure efficiency, safety and quality.
  Coordinates and collaborates on at least three (3) quality/cost containment project every year.
• Collaboration and communication
  Consistently demonstrates effectiveness in coordinating the provision of services with clear, concise and timely communication. Responds to voice mail, pages and e-mails promptly.
  Handles conflict in a professional and ethical manner. Identifies and diffuses stressors/conflict situations to the satisfaction of parties involved.
  Recognizes and supports the skills and qualities of others. Willingly exchanges appropriate professional information with co-workers. Contributes to collaborative practice through active listening, maintenance of customer/colleague confidentiality, and non-judgmental problem solving.
• Professional responsibilities
  Demonstrates excellent communication and team building skills.
  Perceived by other health care workers as approachable when assisting in the achievement of established goals and objectives for improving clinical outcomes.
  Continually strives to suggest and implement ways to improve personal, departmental and institutional performance.
  Establishes and accomplishes a minimum of two professional goals each year. (Goals to be determined by case manager and director).
  Promotes self-awareness and knowledge of current medical standards in the community, recent innovations in patient care and availability of alternative venues and options for care.
  Maintains active membership with professional organizations. Enhances clinical skills through continuing education, obtains and maintains specialized skill certifications. Participates in conferences concerning ongoing evaluation of multidisciplinary dynamics, goal attainment, and implementation of treatment plans.
  Presents in-services and other vehicles for education for patients/families and hospital staff.
• Quality assurance
  Develops a follow up mechanism to assess the satisfaction, functional status, and clinical outcomes of patients after the episode of care.
  Works collaboratively to ensure that patient outcomes are achieved within established time frames using appropriate data. Incorporates literature standards and aggregate data.
  Tracks and analyzes outcome performance data; identifies significant outcomes and assesses current clinical practice in relation to research based best practice.
  Maintains documentation of care management assessment, intervention, follow up and evaluation of care pertinent to utilization and financial information.
• Utilization management
  Maintains correct knowledge and understanding of health plan benefit information, captiation matrixes and other pertinent contract issues as it relates to discharge planning.
  Identifies opportunities for working with physicians and influences practice patterns to positively affect utilization of resources. Interfaces with multidisciplinary team to develop methods to achieve practice changes in various aspects of care.
  Assures appropriate use of patient care resources and monitors their financial impact of the service line.
  Utilizes strategies to manage length of stay and resource utilization of patient population under designated service line and documents the results.
  Collaborates with external and internal case managers to determine best treatment options within payer coverage guidelines.
  Implements programs (early discharge, sub-acute pathways, education, etc.) as indicated to improve utilization outcomes while maintaining quality care standards.
  Complies with payer guidelines on utilization review process to promote optimal reimbursement.
  Identifies and consistently tracks and analyzes unjustified acute hospital admissions/continued stays and denials. Participates with retrospective review and appeal process. Presents this information to respective teams and committees for practice improvement opportunities.
  Make decisions regarding medical necessity of hospital stays with minimal guidance from manager and/or director.

Knowledge, Skills, and Abilities

• Advanced clinical skills and in depth knowledge in area of expertise.
• Understanding of performance improvements and research methodologies.
• Basic knowledge of utilization review criteria and health care finances.
• Excellent communication skills with the ability to interact with all customers.
• Assertive and articulate in difficult situations; skilled in conflict management and resolution.
• Self directed, autonomous, and able to set and achieve priorities.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Salary : $52 - $67