Case Manager RN /LVN (PD)

Overview: Monitors the admissions, continued stay, and discharge of patients following pre-established criteria.

Assures that patients meet InterQual criteria from admission to discharge including appropriateness of level of care.

Conducts interdisciplinary care management rounds.

Ensures collaboration between multidisciplinary healthcare team members, primary physician, community agencies, HMOs/PPOs, CCS, etc., whose services may be required and/or related to the care needs of the patient after hospital discharge.

Monitors nursing and medical plans of care/discharge plans and provides appropriate interventions to assure care is appropriate, coordinated and that avoidable patient days are addressed effectively through education, consultation, and counseling as needed.

Ensure patient centered discharge planning and assessment by communicating the appropriate discharge information and instructions to the primary care giver and primary physician and/or follow-up care agency.

Assures patients are transferred to appropriate approved facilities when required.This position requires providing service to an ill through rehabilitating neonatal through geriatric patient population in a manner that demonstrates an understanding of the functional/developmental age of the individual served.This position requires the full understanding and active participation in fulfilling the Mission of Parkview Community Hospital It is expected that the employee will demonstrate behavior consistent with the Core Values.

The employee shall support Parkview Community Hospitals strategic plan and the goals and direction of the Performance Improvement Plan (PIP) Qualifications: Graduate of an accredited RN or LVN School of NursingTwo years Utilization Management/Case Management experience, preferably in an acute care settingWorking knowledge of Interqual, Intensity of Service/Severity of Illness criteria.Working knowledge of Title XVII and Title XIX.Working knowledge of reimbursement related to Medicare, Medi-Cal, Capitation, and Managed Care is required.Ability to negotiate orders with the physicians in order to assign alternate levels of care.Working knowledge of community resources.Working knowledge of methods to resolve patient needs such as discharge planning, Home Health, DME and SNFs.Ability to case manage smoothly and increase patient/physician satisfaction while staying within guidelines.Ability to track outcomes and report findings.Able to problem solve effectively.Ability to use clinical knowledge to identify potential quality issues, delays in service, post-acute care needs required.Must have excellent oral and written communication, interpersonal, problem-solving, conflict resolu