Position Overview

This role involves coordinating services to optimize patient outcomes through comprehensive assessment, evaluation, and collaboration within patient care delivery systems. The Case Manager II focuses on cost-effective strategies that enhance quality care in today’s healthcare environment for the designated patient population. Responsibilities include utilization management, discharge planning, and acting as a liaison among patients, families, healthcare teams, and insurance personnel.

Key Responsibilities

• Patient Care:
  • Perform thorough assessments to identify patient needs and develop personalized discharge plans.
  • Coordinate services to maximize patient outcomes and participate in service line activities.
  • Serve as a patient advocate, ensuring dignity, confidentiality, and compassionate care.
  • Promote evidence-based practices in case management and utilization review.
• Safety and Compliance:
  • Maintain a safe and clean work environment adhering to infection control and regulatory standards such as The Joint Commission and OSHA.
  • Proactively identify and report safety concerns.
  • Implement cost-efficient strategies that uphold quality care standards.
• 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.
  • Act 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, The Joint Commission standards, and regulatory requirements 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’ 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 exam, 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.