Clinical Case Manager (CASE MGR NEX)

Valid California Registered Nurse License without restrictionGraduation from an accredited school of nursing.Minimum of one (1) year recent Case Management experience in discharge planning and/or utilization review management in an acute hospital.Licensed RN with current working knowledge of discharge planning, utilization management, performance improvement and managed care reimbursement. Knowledge of Medicare, Medi-Cal, and HMO legislation, third party payor contracts, Title XXII, the Joint Commission. Demonstrated knowledge of how these programs/regulations affect the functions and role of the department. Demonstrated ability to incorporate them into departmental systems/processes.Knowledge of professional and ethical standards related to Clinical Case Management such as the Nursing Practice Act, the Codes of Ethics from the American Nurses Association and the Standards of Practice & Scope of Services by the American Case Management Association.Ability to read and comprehend English text and medical terminology; knowledge of medical and nursing treatment plans, levels of care, and area resources; skill in assessing the appropriateness of medical admissions and continued stay.Skill to perform in-depth chart analysis to provide accurate information in a concise, informative manner, identify/analyze problems or issues related to areas of responsibility, developing an appropriate plan, and considering medical needs and resources available.Ability to organize and direct varied health care team professionals in a manner that establishes a good rapport and professional working relationship.Ability to work efficiently and independently, maintaining a calm manner while under pressure. Ability to organize work to accommodate special projects, deadlines and priorities; ability to be both flexible and adaptable in order to coordinate multiple variables and to respond to the need of a multi-faceted work area.Possess clinical skills and knowledge base to assess and refer to discharge planning, possible needs for care necessary to meet patient’s needs on discharge.Understands the need to utilize discretion and maintain confidentiality when discussing patient matters.Successfully applies interpersonal communication skills in areas such as conflict management.