Position Overview

This role involves coordinating comprehensive patient care services to optimize outcomes. The Case Manager II conducts thorough assessments, collaborates with healthcare teams, and manages discharge planning and utilization management to ensure efficient, high-quality care within a dynamic healthcare environment. Acting as a liaison among patients, families, healthcare providers, and insurance representatives, this position emphasizes compassionate advocacy and evidence-based case management practices.

Key Responsibilities

• Patient Care:
  • Perform detailed patient assessments to develop personalized discharge plans.
  • Coordinate services to enhance patient outcomes effectively.
  • Collaborate across care delivery systems and participate in service line activities.
  • Manage utilization review and discharge planning processes.
  • Serve as a primary contact and facilitator for patients, families, healthcare teams, and insurance personnel.
  • Advocate for patient dignity, confidentiality, and compassionate care.
  • Promote evidence-based case management and utilization review practices.
• Safety and Compliance:
  • Maintain a safe and clean work environment adhering to infection control and organizational policies.
  • Ensure compliance with regulatory standards such as The Joint Commission and OSHA.
  • Proactively identify and report safety concerns.
  • Implement cost-effective strategies that maximize quality care.
• Documentation:
  • Accurately document assessments and patient interactions in the Electronic Health Record (EHR) following departmental standards.
• Professional Development and Leadership:
  • Provide mentorship and preceptorship to new nurses and students, supporting their growth.
  • Engage in continuing education and quality improvement initiatives.
  • Serve as a resource for best practices in case management.
• Emergency Preparedness:
  • Activate emergency response protocols during patient emergencies, including Rapid Response Team situations.

Qualifications

• Minimum of two years’ experience as a Registered Nurse in case management or utilization management.
• Familiarity with Prospective Payment System and regulatory standards related to Utilization Management and Discharge Planning.

Competencies

• Technical Skills: Proficient with computer applications including Word; knowledge of various payer types; experience with referral management systems preferred.
• Critical Thinking: Ability to make rapid decisions and adjust plans quickly; strong prioritization skills.
• Communication: Effective verbal and written communication with patients, families, and multidisciplinary teams; strong interpersonal skills fostering collaboration.

Education

• Bachelor of Science in Nursing (BSN) preferred; Associate Degree in Nursing (ADN) with five years of case management experience may be considered.

Licenses and Certifications

• Current Registered Nurse license required.
• Accredited Case Manager (ACM), Certified Case Manager (CCM), or equivalent certification preferred.

Successful candidates must pass a physical evaluation, drug screening, and background checks prior to employment.

This opportunity is located in a regional healthcare setting within the Pacific Southwest region of the United States.