Job Summary:
The Clinical Case Manager is responsible for planning, organizing, and coordinating swing bed admissions, as well as reviewing emergency department admissions and discharges.
This role involves providing administrative support, contributing to process improvements, and collaborating with referral specialists to manage medical records effectively.
The Clinical Case Manager operates under the general supervision of the Director of Nursing.
Key Responsibilities: Financial Assessment: Conduct financial assessments to determine patients' payment sources for inpatient stays, initiating the review process to ensure timely payment for services rendered.
Information Management: Respond to queries from physicians' offices, families, and external facilities regarding patient care and services.
Case Management Services: Deliver case management, social services, utilization review, and discharge planning on a daily basis, including weekends as scheduled.
Admissions Coordination: Identify and manage swing bed admissions, verifying that all admission requirements and necessary screenings are met prior to transfer.
ED Coordination: Review emergency department admissions and discharges; contact ED patients to facilitate follow-up visits with primary care providers or coordinate necessary transfers.
Relationship Development: Establish and maintain relationships with specialty offices to enhance patient transfers and care collaboration.
Interdisciplinary Collaboration: Participate in interdisciplinary team meetings and utilization review sessions to support patient care strategies.
Patient Chart Review: Assess patient charts for counseling requests and evaluate the need for interventions or appropriate community resources.
Availability: Must be available for at least two Saturdays per month, depending on patient admissions.
Required Qualifications: Three to five years of clinical nursing experience.
Current licensure to practice nursing in the state of California.
Proficiency in Microsoft Office, Athena, EMR, and Point Click Care.
Strong ability to multitask and work effectively in a fast-paced environment.
Preferred Qualifications: One to two years of experience in case management or a related field.
Bachelor's degree in nursing.
Bilingual in Spanish.
Certifications: Basic Life Support (BLS) certification required.
Advanced Cardiac Life Support (ACLS) certification preferred.
Education: Bachelors Degree