Case Manager RN

The Clinical Case Manager facilitates the integration and coordination of major aspects of utilization review and discharge planning for patient needs. This position requires a high level of clinical judgment, problem-solving skills, creativity, organizational and priority setting abilities, with excellent communication skills. Critical aspects of the role involve the assessment of clinical information to determine medical necessity for the identified level of care, assessment for appropriate services needed and resources available, and to facilitate the coordination of both internal and external health care providers to ensure optimal continuity of appropriate and cost-effective care. The Clinical Case Manager must effectively communicate with both internal and external providers and health plans, as well as community resources, to optimize medically necessary services.

The Clinical Case Manager demonstrates the ability to fulfill responsibilities through clinical assessment, accurate and sound judgment, application of standardized criteria, and maintaining professional communication. The goal of coordinated discharge planning and utilization is achieved by actively directing and involving members of the multi-disciplinary team, outside providers, community resources, and third-party payors. The Clinical Case Manager accurately maintains and tracks pertinent data and statistics specific to area of practice, such as delays in service, patients who lack medical necessity for acute hospital admission, denials for continued stays, and other factors affecting appropriate utilization of health system resources.

This Case Manager's focus is in the Emergency Department as an ED Case Manager, Nights, 12-hour shifts at 90%.

Apply By Date

November 24, 2024 by 11:59 p.m.

Minimum Qualifications

• Valid California Registered Nurse License without restriction
• Graduation from an accredited school of nursing.
• Minimum of 1-year recent Case Management experience in discharge planning and/or utilization management in an acute hospital.
• 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.
• For full consideration, applicants are encouraged to upload license, certification and/or educational degree if required of the position.

Preferred Qualifications

• BSN Preferred

Key Responsibilities

• 40% - Utilization Management and Case Finding
• 30% - Coordination and Implementation of Discharge Plan
• 15% - Communication, Coordination and Documentation
• 5% - Secure Authorization for Care and Reimbursement for Hospital and Physician
• 5% - Quality and Education
• 5% - Denials and Appeals Management

Department Overview

The purpose of the Clinical Case Management Department is to support the interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions.

Department Specific Job Scope

The purpose of the Clinical Case Manager is to support the interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Clinical Case Manager helps drive change by identifying areas where performance improvement is needed (e.g., day-to-day workflow, education, process improvements, patient satisfaction). The Clinical Case Manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and create a safe discharge plan. Facilitation of the collaborative management of patient care across the continuum, completing utilization review around LOC and authorization concerns, and intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.

This Case Manager's focus is in the Emergency Department as an ED Case Manager, Nights, 12-hour shifts at 90%.

POSITION INFORMATION

• Salary or Pay Range: $67.88 - $99.43
• Salary Frequency: Hourly
• Salary Grade: 105
• UC Job Title: CASE MGR NEX
• Number of Positions: 2
• Appointment Type: Staff: Career
• Percentage of Time: 90%
• Shift Hours: Night shift 9:00 pm-9:30 am, 12 hours
• Location: Surgery & Emergency Serv PAV (HSP010) - Sacramento, CA
• Union Representation: HX-Healthcare Professionals
• Benefits Eligible: Yes
• Hybrid/Remote/Onsite: This position is 100% on-site
• This is not a H-1B visa opportunity.

Benefits

Outstanding benefits and perks are among the many rewards of working for the University of California. UC Davis offers a full range of benefits, resources and programs to help you bring your best self to work, as well as to help you and your family achieve your health, wellness, financial and career goals. Learn more about the benefits below and eligibility rules by visiting either our handy Benefits Summary for UC Davis Health Employees or Benefits Summary for UC Davis Employees and our Benefits Page.

If you are represented by a union, benefits are negotiated between the University of California (UC) and your union and finalized in a contract. Read your bargaining unit's employment contract, stay abreast of current negotiations and learn about collective bargaining at UC: https://ucnet.universityofcalifornia.edu/labor/bargaining-units/index.html

* High quality and low-cost medical plans to choose from to fit your family's needs
* UC pays for Dental and Vision insurance premiums for you and your family
* Extensive leave benefits including Pregnancy and Parental Leave, Family & Medical Leave
* Paid Holidays annually as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Paid Time Off/Vacation/Sick Time as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Continuing Education (CE) allowance and Education Reimbursement Program as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Access to free professional development courses and learning opportunities for personal and professional growth
* WorkLife and Wellness programs and resources
* On-site Employee Assistance Program including access to free mental health services
* Supplemental insurance offered including additional life, short/long term disability, pet insurance and legal coverage
* Public Service Loan Forgiveness (PSFL) Qualified Employer & Student Loan Repayment Assistance Program for qualified roles
* Retirement benefit options for eligible roles including Pension and other Retirement Saving Plans. More information on our retirement benefits can be found here
* UC Davis cares about building a community, which is why we provide resources to enhance diversity, equity and inclusion as well as Employee Resource Groups (ERGs) to support our staff

Physical Demands

• Standing - Frequent 3 to 6 Hours
• Walking - Frequent 3 to 6 Hours
• Sitting - Frequent 3 to 6 Hours
• Lifting/Carrying 0-25 Lbs - Occasional Up to 3 Hours
• Pushing/Pulling 0-25 Lbs - Occasional Up to 3 Hours
• Bending/Stooping - Occasional Up to 3 Hours
• Squatting/Kneeling - Occasional Up to 3 Hours
• Twisting - Occasional Up to 3 Hours
• Climbing (e.g., stairs or ladders) - Occasional Up to 3 Hours
• Reaching overhead - Occasional Up to 3 Hours
• Keyboard use/repetitive motion - Frequent 3 to 6 Hours

Environmental Demands

• Loud noise levels - Occasional Up to 3 Hours

Mental Demands

• Sustained attention and concentration - Frequent 3 to 6 Hours
• Complex problem solving/reasoning - Frequent 3 to 6 Hours
• Ability to organize & prioritize - Frequent 3 to 6 Hours
• Communication skills - Frequent 3 to 6 Hours
• Numerical skills - Frequent 3 to 6 Hours
• Constant Interaction - Frequent 3 to 6 Hours
• Customer/Patient Contact - Frequent 3 to 6 Hours
• Multiple Concurrent Tasks - Frequent 3 to 6 Hours

Work Environment

• Works overtime as defined by the collective bargaining agreements, floats to other areas and works weekends and holidays.
• References reflect an overall meet or exceeds.

Special Requirements

• This is a critical position, as defined by UC policy and local procedures, and as such, employment is contingent upon successful completion of background check(s), including but not limited to criminal record history background check(s)
• This position is designated as a mandated reporter under CANRA and UC policy, and employment is contingent on compliance with applicable policies, procedures and training requirements

Diversity, Equity, Inclusion and Belonging

At UC Davis, we're solving life's most urgent challenges to bring a fuller, healthier, and more resilient world within reach. We grow from every challenge we take on and we don't just maintain - we improve. We recognize that creating an inclusive and intellectually vibrant organization means understanding and valuing both our individual differences and our common ground. The most comprehensive solutions come from the most diverse minds and you belong here. As you consider joining UC Davis, please explore our Principles of Community, our Clinical Strategic Plan and strategic vision for research and education, and our latest efforts to outgrow the expected. The University of California, Davis is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California's Affirmative Action Policy, please visit: https://policy.ucop.edu/doc/4010393/PPSM-20

For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

Because we want you to be seen, our recruiting process at UC Davis fosters authenticity, diversity, and inclusion. Studies have shown that some people may not apply to jobs unless they meet every single qualification. Each unique role at UC Davis has a set of requirements and you could be perfect for this role, or you could be perfect for the next role! Don't meet all the requirements? We still encourage you to apply! #YouBelongHere