Case Manager (RN) - Surgical Services, Full-time, Days

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Day - 08 Hour (United States of America)

Case Managers are licensed nursing professionals responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients. Major responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness of services as well as appropriate utilization of services; and ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. Case Managers act as consultants to the clinical team, service lines, and other departments regarding patient assessment and patient care and participate in program development and quality improvement initiatives. In their role, Case Managers, by applying guidelines and collaborating with multidisciplinary teams, influence and direct the delivery and quality of patient care. A hospital-based case management system has as its primary goal to ensure the most appropriate use of services by patients and, toward that end, to avoid duplication and misuse of medical services, control costs by reducing inefficient services, and improve the effectiveness of care delivery. Objectives are to facilitate timely discharge; prompt, efficient use of resources; achievement of expected outcomes; collaborative practice; coordination of care across the continuum; and performance/quality improvement activities that lead to optimal patient outcomes.

About Stanford Health Care
At Stanford Health Care, the possibilities to explore your interests and advance your profession are limitless. Whether you're starting the journey as a new graduate nurse or a highly experienced nurse, Stanford can be the catalyst to empower and transform your career. Our highly engaged healthcare teams provide the needed structure and opportunities to achieve your desired professional growth. Browse our wide range of nursing specialties and practice areas. We'd love the opportunity to bring you on as part of the Stanford Health Care team.

Diversity & Inclusion: Cultivating a workplace in which diversity is celebrated and all people are included, respected valued and appreciated as the most valuable asset of Stanford Health Care. Employee Resource Groups (ERGs) launched to be cultural catalysts, innovation hubs, leadership development and talent communities that contribute breakthrough results and advance a culture of inclusion and belonging for all. All groups are inclusive and everyone is invited to join and become an active member. For more information, please click on the following link: https://careers.stanfordhealthcare.org/us/en/diversityandinclusion

Stanford Health Care's Professional Practice Model: The SHC Professional Practice Model (PPM) illustrates how nurses support the organization's mission, vision, and national professional standards of nursing practice. Symbolizing our patient-centered beliefs and values, the PPM exemplifies nurse autonomy over clinical practice and the practice environment, depicting effective communication between interprofessionals to result in high-quality patient care.

ANCC Magnet Designation: The American Nurses Credentialing Center (ANCC) Magnet Model provides a framework for clinical, operational, and leadership practice, serving as a roadmap for Stanford Nursing's ongoing pursuit toward nursing excellence.

Watson Caring Science: Beginning in 2007, SHC embraced Jean Watson's transformative "Caring Science" theory of human caring and love. This intertwining of "Caring Science" with nursing practice translates into increased intentionality and a deepening of authentic presence; thereby renewing nurse relationships through universal, ethical, and person-centered care.

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This is a Stanford Health Care job.

Locations
Stanford Health Care

Description:

Coordination of Care -- Manages each patient's transition through the system and transfers accountability to the appropriate person upon entry into another clinical service or discharge.

Discharge Planning - - Coordinates and facilitates timely implementation of discharge plans for assigned patients with complex needs in collaboration with other interdisciplinary team members; arranges follow-up care as appropriate.

• Education/Consultation -- Acts as an educational resource and provides consultation to patients and their families, hospital medical personnel regarding the discharge planning process and applicable regulatory requirements; educates the staff on case management; and provides specific information related to case types.

• Lead Work -- May lead the work of administrative/clinical support staff responsible for assisting with case management for an assigned patient caseload.

• Other -- Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned.

• Patient Assessment / Plan of Care -- Functions as a resource to and collaborates with physicians, social workers, nurses, and other interdisciplinary team members to assess, plan, and coordinate patient care needs and/or performs patient assessment and develops a plan of care to assure consistent, timely, and appropriate care is provided in a patient-focused manner.

• Quality Improvement -- Participates in quality improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection; participates in clinical process improvement teams within the department, service lines, and hospital.

• Third-Party Reimbursement -- Collects, analyzes reports and reviews patient information with third-party payers to assure reimbursement for patient services/procedures. Communicates with review organizations / payers to provide requested clinical and psychosocial information to assure reimbursement.

• Utilization Review -- Reviews prospectively, concurrently and retrospectively all inpatients for appropriateness of admission, level of care, and determines appropriate length of stay. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes analyzes and addresses aggregate variances as well as variances from individual patients and shares this information with staff, physicians, and administration.

Knowledge, Skills, and Abilities

These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally

demonstrated through qualifying experience, education, or licensure/certification.

• Collect and record data, evaluate data and statistics, and maintain effective reporting systems

• Develop and perform patient assessment and plan of care  

• Monitor and assure the patient's access to the appropriate level of care; the right health care providers; and the correct setting and services to meet the patient's needs; promote coordination and continuity in patient health care

• Provide age-appropriate assessments, interpretation of data, and delivery of interventions

• Provide appropriate patient care and clinical information when patients are admitted, referred, transferred, or discharged

• Remain knowledgeable regarding available treatments and services

• Resolve conflicts and/or negotiate with others to achieve positive results; establish and maintain effective interpersonal relationships

• Understand, interpret and apply complex federal and state hospital compliance laws, rules, regulations and guidelines

• Work effectively with individuals at all levels of the organization

• Knowledge of available patient services and treatment

• Knowledge of current theories, principles, practices, standards, emerging technologies, techniques and approaches in the nursing profession, and the health care system, and the responsibility and accountability for the outcome of practice

• Knowledge of evaluation and assessment techniques

• Knowledge of financial processes of various private and public funding sources for health care services/procedures

• Knowledge of hospital operations, organization, systems and procedures and laws and regulations pertaining to the operation of hospitals in California

• Knowledge of medical terminology and related levels of care and treatment

• Knowledge of the full continuum of care available to patients, interrelationships of the care components, and their effective integration

• Knowledge of the models of case management, including the principles and practices of discharge planning, utilization review, and quality assurance/improvement

• Knowledge of the variables that affect the processes and outcomes of patient health care

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.