Case Manager RN

    Providence Health & Services
    Santa Monica, CA 90401
    Full-time
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    Job Description

    Providence is calling a Case Manager (Full Time/Day Shift) to Saint Johns Health Center in Santa Monica, CA.

    We are seeking a Case Manager Patient Care Services (RN) who will chart review of Medicare, other federally funded, and private insurance patients according to contract requirements using currently approved criteria. The goal is to evaluate the appropriateness of the admission and the continuing levels of care, using established guidelines for quality of care and reimbursement purposes.

    In this position you will have the following responsibilities:
    • Perform assessment/data collection
      • Assess patients for level of care etc.
    • Formulate goal directed plan based on patient outcomes:
      • Initiate, individualize, and modify plan of care
      • Collaborate with other services
      • Plan discharge/transfer
    • Implement role based on department and hospital standards:
      • Follow established protocols and procedures
    • Evaluate effectiveness of care
    • Identify patient/significant other learning needs and demonstrates measures to meet these
    • Delegate to appropriate patient care team members
    • Demonstrate applied knowledge when evaluating care for selected patient populations including care appropriate to the age of patients served on the unit
    • Demonstrate competency in selected administrative skills. Includes but not limited to:
      • Prepare and modify HMO list
      • Prepare charts reviewing to evaluate length of stay/needs
      • Prepare clinical reviews of HMO and PPO patients
      • Prepare discharge planning
      • Prepare retroactive reviews
    • Demonstrate responsibility and accountability for own professional practice in regards to:
      • Attendance, punctuality, and confidentiality
      • Positive public relation image and working relationships
      • Obtain necessary knowledge and skill needed to maintain competence
      • Complete all mandatory requirements, including annual safety films, CPR, infection control and annual physical
    • Participate in the development and attainment of team, department and hospital goals including:
      • Attend and participate in team meetings
      • Volunteer or accept assignment for projects
      • Mission, vision and team ground rules
    • Demonstrate documentation on patient care records and unit forms

    Qualifications :

    Required qualifications for this position include:
    • Sufficient for license
    • Current California RN License
    • Minimum of two (2) years practical nursing experience
    • Previous coding and abstracting experience
    • Ability to determine acuity of medical condition through knowledge of medical terminology and knowledge of resource persons and places
    • Excellent communication and public relations skills required
    • The ability to present oneself in a professional manner
    About the hospital you will serve:

    Providence Saint John's Health Center in Santa Monica, California, is part of Providence Health & Services, an integrated, not-for-profit network of hospitals, care centers, medical clinics, home health services, affiliated services and educational facilities in the western United States. Founded in 1942, Providence Saint John's Health Center enjoys a reputation for clinical excellence across many disciplines.

    The 266-bed health center has a medical staff of more than 900 physicians, 1,800 employees and a host of volunteers who share a commitment to providing quality care for all.

    Posting ID: 547516671Posted: 2020-07-14