Care Coordinator RN II - Case Management

📁
Nursing
💼
Sonoma County Entities
📅
R333449 Requisition #
We are looking for a Care Coordinator RN II for the Case Management Department at Santa Rosa Memorial Hospital. Apply Today! Applicants that meet qualifications will receive a text with some additional questions from our Modern Hire system.  
 
Location: Santa Rosa, CA
Work Schedule:  Full Time - 80 Biweekly Hours
Shift: 8-hour, Days
 
Job Summary:
The Care Coordinator Nurse, in partnership with physicians, nursing and healthcare team members, utilizes clinical and professional skills to assess patient and family needs for care coordination, medical, discharge and psychosocial needs and establishes plans for effective management throughout the continuum of care, including pre and post acute care. The Care Coordinator role includes proactive, individualized planning for patients' progress across the continuum that optimizes quality of care, patient satisfaction, and utilization and reimbursement to meet patient needs and organizational strategic objectives.
 
Essential Functions:
  • Demonstrates the ability to use all components of the nursing process including assessment, planning, implementing and evaluating care to meet the patient needs.
  • Assessment and Planning:
    • Screens and identifies high risk patients and patient support systems requiring care coordination, and proactively intercedes as necessary in a timely and effective manner. Makes referrals to the appropriate disciplines.
    • Assumes leadership role in managing identified high risk cases, and oversees the development of optimal transition plans. Monitors the patients’ progress towards meeting physical, emotional, educational, financial and spiritual health goals by addressing any variances in the pathways, protocols, etc. to ensure optimal outcomes.
  • Coordination and Implementation:
    • Demonstrates knowledge and coordinates services required for identified patients in collaboration with the clinical treatment team to ensure services are provided across the continuum. Serves as a liaison to community services for assigned population and advocates on patient’s behalf. Facilitates transition planning across the continuum by involving patient, family, physician, staff nurse and any other disciplines. Works collaboratively with other members of the Care Management team, to ensure smooth transition across the continuum and appropriate reimbursement for services provided.
  • Monitoring and Evaluating:
    • Identifies and analyzes variances from expected outcomes and works towards resolution. Collaborates with staff and treatment team to modify plan of care, as needed, as key clinical and financial information is identified.
    • Monitors the treatment plan and progress map for the quality, quantity, timeliness, and effectiveness for services provided, to ensure that they are appropriate, cost-effective and maximize outcomes. Documents and tracks avoidable days.
  • Communication:
    • Fosters cordial, positive and professional interpersonal relationships with patients, family members, physicians, members of the healthcare team, insurance companies, community agencies and peers. Negotiates effectively with patients, family members, physicians, insurance companies, other providers, community agencies, and staff and peers to provide efficient and successful patient transitions through the continuum. Maintains adequate and timely progress notes in the patient’s medical record. Identifies administrative issues that may affect reimbursement or increased length of stay (insufficient medical record documentation, lack of timely test or treatment, etc.). Communicates findings to the appropriate department or individual to ensure maximum coverage and reimbursement.
  • Education:
    • Collaborates with healthcare team in providing client/family education related to patient’s diagnosis and return to health. Stays current in trends in the industry for Care Management, disease management, or related topics.
    • Assists in educating medical and multidisciplinary staff on regulatory guidelines, utilization issues, transition planning, development and use of protocols, pathways, etc. Maintains current knowledge of and effectively applies clinical screening tools (i.e., Milliman and Interqual guidelines), Medicare, and other regulatory criteria for medical appropriateness and utilization optimization. Possesses a working knowledge of financial terms, (i.e., PPO, HMO, capitation, Length of Stay), DRG reimbursement and patient requirements/expectations. Maintains professional knowledge of best practice discharge planning concepts and community resources and utilization management legislation. Maintains current knowledge of Title 22, JCAHO guidelines, and the Hospital’s Utilization Management Plan.
  • Quality:
    • Participates in department quality and performance improvement activities. Facilitates audits as required. 
    • Facilitates Core Measure compliance. Promotes the prevention and early identification of hospital acquired conditions and participates in the identification of root causes of hospital readmissions. In all interactions, promotes patient satisfaction. Ensures that quality of care concerns are reported to the appropriate person and/or Risk Management.
 
Skills:
  • Demonstrates effective interpersonal and communication skills.
  • Demonstrates tact, diplomacy, negotiation skills, and customer relations.
  • Ability to apply creative problem solving skills.
  • Ability to prioritize assignments and effective time-management skills.
  • Knowledge of diagnosis, expected treatment and discharge planning needs.
  • Knowledge of clinical and psychosocial aspects of patient care.
  • Ability to present a professional presence and appearance.
  • Detail-oriented, flexible, and committed to patient advocacy
 
Minimum Position Requirements:
Experience:
  • Experience performing utilization management.
  • 3 years Clinical experience.
Licenses/Certifications: Registered Nurse, with a current California license from an accredited school of Nursing.
 
Preferred Position Qualifications:
Education: Bachelor's Degree in Nursing.
Experience:
  • Experience in performing either case management, utilization review, discharge planning or quality review.
  • Experience with clinical pathways.
Licenses/Certifications: Case management certification within 1 year of hire.
 
 
 

Providence St. Joseph Health (Providence) has worked for decades to improve health and quality of life in California's North Bay region, starting in Sonoma County, where the Sisters of St. Joseph of Orange opened the doors of Santa Rosa Memorial Hospital in 1950. Today, we continue the mission begun by the Sisters to those we serve through an integrated spectrum of primary, urgent, acute, outpatient, palliative care and regional referral services. Sonoma County facilities aligned with Providence include the 278-bed Santa Rosa Memorial Hospital, the region's only Level II trauma center. In addition, the 80-bed Petaluma Valley Hospital and 43-bed Healdsburg Hospital are secular (non-religious) affiliates of Providence. Our services also encompass three Urgent Care centers, Hospice of Petaluma, Memorial Hospice and North County Hospice, the Annadel Medical Group doing business as St. Joseph Health Medical Group, as well as the St. Joseph Home Care Network (post-acute care services). We act as a regional referral hub for outlying hospitals, while also providing outpatient behavioral health care, education to promote health and prevent chronic disease, rehabilitation, oral health care, community benefit programs, and more, all fostering health and quality of life throughout the area.

Providence provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Providence complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Positions specified as "on call/per diem" refers to employment consisting of shifts scheduled on as "as needed basis" to fill in for staff vacancies.

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