Talent.com
Esta oferta de trabajo no está disponible en tu país.
RN Care Manager Inpatient Part-Time (10hrs)

RN Care Manager Inpatient Part-Time (10hrs)

MLK Community HealthcareLima Metropolitana, Lima, Peru
Hace más de 30 días
Descripción del trabajo

Overview

RN Care Manager Inpatient Part-Time (10hrs) – MLK Community Healthcare

Position Summary : The Case Manager I supports the physician and interdisciplinary team in facilitating patient care, aiming to enhance clinical outcomes and patient satisfaction while managing cost of care and providing timely, accurate information to payors. The role integrates and coordinates utilization management, care progression, and care transition.

Essential Duties And Responsibilities

Assessment

  • Completes a comprehensive assessment to identify opportunities for intervention that are appropriate and realistic for the patient / family’s psycho-social, cultural, spiritual, and physical plan of care.
  • Assesses patient healthcare needs and goals across physical, functional, psychosocial, environmental, and financial domains.
  • Completes and documents timely clinical reviews based on medical necessity and payer requirements.
  • Communicates with attending physician regarding appropriateness of admissions, resource utilization, and documentation support for continued stay.
  • Assesses readmission risk based on established hospital criteria.

Planning

  • Develops discharge plans that reflect medical necessity and payer requirements for safe, effective, and timely transition.
  • Considers patient’s clinical condition, social and financial resources to determine the most appropriate care setting and resources required for a safe transition of care.
  • Considers readmission risk and socio-economic factors in transition planning; engages patient and family / support network in plan development.
  • Collaborates with the interdisciplinary team to reassess and adjust the plan for progression and transition.
  • Advocates for the patient with payers / IPA to optimize care progression and transition.

    • Implementation

  • Coordinates progression of care to address ongoing needs of patient and family.
  • Identifies psychosocial and financial barriers and collaborates with Clinical Social Work as needed.
  • Identifies discharge planning needs and facilitates transfers to appropriate venues.
  • Applies knowledge of clinical requirements, payer networks, and patient environment to create a transition plan.
  • Identifies and facilitates home care and durable medical equipment needs at discharge.
  • Facilitates palliative or hospice care when indicated.
  • Maintains active communication with physicians, nursing, and the interdisciplinary team to ensure timely care progression and outcomes.
  • Oversees discharge planning and safe transitions to community settings; resolves system problems impeding progress and seeks consultations to expedite care as required.

    • Evaluation

  • Develops and evaluates case management plans and protocols with the interdisciplinary team.
  • Evaluates actions to ensure cost-effective care, including LOS, cost reporting, and readmission monitoring.
  • Uses avoidance of unnecessary days reporting to identify barriers to progression of care.

    • Communication / Collaboration

  • Interfaces with interdisciplinary team, community providers, payers, and patient / family to ensure safe, effective plans and smooth transitions.
  • Maintains communication with Patient Financial Services and HIM as needed to support billing and authorization processes.
  • Collaborates with medical / nursing / ancillary staff to remove barriers to care.
  • Reviews patient care with attending physicians and consultants; manages deviations from the plan of care.
  • Participates in patient care conferences and family meetings; provides clinical guidance to nursing / ancillary personnel as needed.
  • Maintains communication with Nurse Managers and other Case Managers regarding patient care and system issues.
  • Reports medical / legal issues to Risk Management and Administrative parties as appropriate.
  • Facilitates peer-to-peer discussions on medical necessity for admission by the payer.
  • Utilizes conflict resolution skills to resolve issues and ensure timely progress.

    • Professionalism

  • Maintains professional nursing practice and ongoing competency; participates in departmental meetings and shares knowledge on case management.
  • Understands Medicare Conditions of Participation related to discharge planning, patient / family engagement, and financial responsibility communication.
  • Respect for patient dignity with attention to privacy and confidentiality; proactively addresses issues with a positive problem-solving approach.
  • Demonstrates respect and care for all customers regardless of diagnosis or socio-economic status; maintains positive interpersonal relations.
  • Performs additional related duties as assigned.

    • Position Requirements

  • Education : Bachelor of Science in Nursing preferred; Associate degree in Nursing required.
  • Qualifications / Experience : 1 to 3 years of hospital or related experience required; internal candidates with at least 18 months acute care case management / coordination experience may be considered in lieu of nursing clinical experience.
  • Ability to navigate and connect with outside provider networks (Health Plans, IPA’s, and FQHCs).
  • Special Skills / Knowledge : Bilingual language skills preferred (Spanish); basic computer skills.
  • Licenses / Certifications : Current California Nursing license; Current Basic Life Support (BLS); Certification in Case Management preferred.
  • Other : ED Care Managers must complete annual Workplace Violence Prevention Program / Certificate per policy within 90 days of hire / transfer.

    • Seniority level

  • Mid-Senior level

    • Employment type

  • Part-time

    • Job function

  • Health Care Provider

    • Industries

  • Hospitals and Health Care

    • Note : This refined description retains the core job information while improving formatting and removing extraneous content. It does not include non-relevant postings or promotional copy.

    #J-18808-Ljbffr

    Crear una alerta de empleo para esta búsqueda

    Manager • Lima Metropolitana, Lima, Peru