CASE MANAGER (RN/LPN), M-F

POSITION: 

*Assist with new patient admissions 

To provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs.  The overall goal of the position is to enhance the quality or patient management and satisfaction, to promote continuity of care and cost effectiveness through the integrating and functions of case management, utilization review and management and discharge planning.  Has accountability for the care, coordination and discharge planning of all patients.  Coordinates the integration of the social services function into patient care.  Adhere to departmental goals, objectives, standards of performance and policies and procedures.  Ensures compliance with quality patient care and regulatory compliance.   
 
REPORTING: 
This position is responsible to the Administrator.   
 
FLSA STATUS:      Non-Exempt 
 

ESSENTIAL JOB FUNCTIONS: 

• Coordinate the integration of social services/case management functions into patient care, discharge, and home planning processes with other departments, external service organizations, agencies and healthcare facilities.   
• Act as a patient advocate:  investigate and report adverse occurrences, and perform staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery   
• Promote effective and efficient utilization of clinical resources 
• Mobilize resources and interview, as needed, to achieve expected goal to assist in achieving desired clinical outcomes within the desired timeframe 
• Conduct review for appropriate utilization of services from admission through discharge.  Evaluate patient satisfaction and quality of care provided
• Initiate and present insurance “denial” letters, as appropriate 
• Assess patient care required throughout continuum of care for diagnosis, procedures and DRGs 
• Communicate with IDT at regular intervals throughout stay and develop an effective working relationship.  Assist IDT to maintain appropriate cost, case, and desired patient outcomes   
• Introduce self to patient and family and explain clinical case manager role and process for patient and family to contact Clinical Case Manager   
• Assess patient’s progress through expected stay course   
• Refer cases where patients and/or families would benefit from counseling required to complete complex discharge plan to social worker   
• Serve as patient advocate.  Enhance a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions 
• Facilities interdisciplinary patient rounds and/or conference to review treatment goals, optimize resource utilization, provide family education and identified post-stay needs   
• Collaborate with clinical staff in the development and execution of the plan of care and achievement of goals   
• Coordinate the provision of services to patients, families, and significant others to enable them to deal with the impact of illness on the individual family functioning and to achieve maximum benefits from healthcare services   
• Assist in the admissions process, as directed:  providing tours to perspective patients, family members or responsible parties, completing the admissions packet and submitting to corporate, conducting orientation to the facility, etc.   
• Assist with discharge planning, i.e. appropriate placement and arrangements, home health services, transportation, etc.   
• Make arrangements for obtaining adaptive equipment, clothing, and personal items 
• Make referrals and obtain services from outside entities, i.e. talking books, absentee ballots, facility wheelchair transportation and the like   
• Assist patients with financial and legal matters, i.e. Medicare, Medi-cal benefits, Social Security, VA, referrals to funeral homes for preplanning arrangements, etc.  
• Complete Social Service Assessment and MDS section for each patient within 7 days after admission, maintain progress notes at least quarterly or more frequently if needed   
• Identify and support patient’s individual needs and preferences, customary routines, concerns and choices through the assessment and care planning process   
• Document on the patient’s plan of care all identified social service problems with appropriate approaches and time measurable goals   
• Promote actions by the staff that maintain and enhance each patient’s dignity in full recognition of each patient’s individuality   
• Assist patients to determine how they would like to make decisions about their health care, and whether or not they would like anyone else involved in these decisions   
• Assist staff to inform patients and those they designate about the patient’s health status and health care choices and ramifications including advance directives   
• Participate in Interdisciplinary Care Plan conferences and develop plan of care to ensure that special social service needs are met   

JOB FUNCTIONS: 

• Demonstrate knowledge of, and respect for, the rights, dignity and individuality of each resident in all interactions 
• Appreciate the importance of maintaining confidentiality of resident and facility information 
• Demonstrate honesty and integrity at all times in the care and use of resident and facility property 
• Assist with regularly scheduled Resident and Family Group meetings as requested   
• Assist in resolution of grievances as voiced by patient, family, responsible party and ombudsman  
• Perform other duties as may be assigned 

PHYSICAL CAPACITIES:   (With or Without the Aid of Mechanical Devices) 

• Must be able to move intermittently throughout the workday. 
• Must be able to see and hear or use prosthetics that will enable these senses to function adequately to ensure that the requirements of this position can be fully met. 
• Must meet the general health requirements set forth by the policies of this facility which includes an annual TB screening and physical examination.  
• Must be able to stand and walk.  
• Must be able to lift and carry up to 25 pounds.   
• Infrequent transporting of residents.   
• Must be able to cope with the mental and emotional stress of the position. 

ENVIRONMENTAL CONDITIONS:      
Inside work, normal temperatures, some noise, occasional fumes/odors, chemical exposure and potential exposure to bloodborne pathogens. 
 
This job cannot be performed without exposure to the stresses associated with an intimate, 24 hour skilled care environment that delivers care and services primarily to disabled and cognitively impaired residents in an aging population.  Examples of these stresses include, but are not limited to: emergency health or safety response, weekend and holiday duty, unusual or impaired behavior by residents, family reactions to having a loved one in a nursing home, death and dying, oversight of state surveyors, ombudsmen and federal officials, presence of consultants and attorneys, and variable involvement of medical staff. 

QUALIFICATIONS/REQUIREMENTS: 

Education:  
    LVN graduate from an accredited School of Nursing, Bachelors of Science in Nursing or Masters in Social Work, BSW, or BA Sociology License:      

Current, valid, Licensed Vocational Nurse or Registered Nurse licensure to practice in the State of  California  
    Appropriate certification in case management preferred, e.g. Commission for Case Management  Certification (CCMC); Association of Rehabilitation Nurses (ARN) 

Work Experience:     Requires a minimum of 2 years of utilization review/case management experience or social work experience.  Requires at least six months prior LVN or RN experience in the past two years in a general acute care hospital setting, or acquired equivalent competency appropriate to the type of  
    sub-acute residents that the facility provides care to.  

Language Skills: 

• Must be able to read, analyze, and interpret common scientific and technical information, and to be easily understood through verbal communication in the English language.   

Mathematical Skills: 

• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. 
• Ability to perform these operations using units of weight measurement, and volume. 

Communication Skills: 

• Must have exceptional communication and customer service skills, and be empathetic.   
• Ability to effectively communicate with patients, families, responsible parties, staff and outside resources and agencies.   

Salary : $45 - $55