Case Manager

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• Reviews medical information on all assigned patients and provides clinical justification of the admission using hospital/industry approved criteria within one working day including identification of the appropriate level of care.
• Responsible for working collaboratively with all healthcare team members to develop and implement treatment plans that support the patient-centered plan of care for both individual patients and the service-line.
• 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.
• Communicates accurately with Supervisor Financial Counselors Contract Dept. and/or Patient Accounting for pertinent account information or service needs.
• Coordinates with all facets of a patients admission/discharge or outpatient visit/follow-up; 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.
• Consistently manages denials and facilitates the appeals process while keeping the physician and appropriate departments briefed on denial and progress of appeal
• Coordinates activities of high risk patients related to inpatient care goals and 30 days after discharge by home visits and phone calls.
• Determines appropriate discharge options and identifies medical/psychological/social conditions that may require additional therapeutic support/treatment and communicates this to the staff contact at the higher level of care facility.
• Educates coach and promote self-management skills and patient adherence to treatment plan by utilizing appropriate education methods based on the individualized patient needs abilities preferences and readiness to learn with respect to cultural social or ethical considerations.
• Actively participates in daily Patient Rounds. Attends staff meetings and serves on hospital wide committees
• Employee must perform all duties and responsibilities in accordance with the C-I-CARE Standards of the Hospital. C-I-CARE is the foundation of Stanford Healthcare Tri Valley patient-experience and represents a framework for patient-centered interactions

• Graduate from an accredited school of nursing Required
• BSN Preferred

• 2 years to 3 years acute care nursing experience needed Required
• 2 years to 3 years Utilization Review acute care hospital Preferred

• Ability to work independently and function effectively as a member of an interdisciplinary team.
• Basic Computer skills required.
• Strong communication and interpersonal skills
• Strong advocacy and problem-solving skills
• Strong attention to detail
• Knowledge of the principles of growth and development and the ability to assess and interpret data regarding a patients status to identify the patients needs and appropriate care
• Knowledge of acute care in relation to safety security and joint commission standards

• NursingRN - Registered Nurse - State Licensure And/Or Compact State Licensure required
• Current American Heart Association Certification for Basic Life Support for HealthcareProviders required
• ACM or
• CCM - Certified Case Manager preferred

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination inall ofits 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.

The salary of the finalist selected for this role will be set based on a variety of factors including but not limited to internal equity experience education specialty and training. This pay scale is not a promise of a particular wage.