Job Summary
- Exempt: No
- Collaborates with the patients and their families, the patient's physicians, and care providers in
- coordinating the care of the patient, utilizing skills of advocacy, communication, management of fiscal
- and material management, regulatory compliance, and education. Identifies, facilitates and
- coordinates the appropriate services, resources, providers and facilities throughout the continuum of
- care. Acts as a liaison with physician(s) to assure all covered aspects of treatment are fully
- documented and ensure patients receive timely, appropriate care during their hospitalization. This position is represented by RCHEA.
Standards of Behavior
Line of Responsibility and Authority
- LINE OF AUTHORITY: Case Manager-RN - Case Management Director
Licenses and Certifications
Professionalism and Self-Development
Education and Qualifications
- EDUCATION AND EXPERIENCE: Graduate from a BRN approved school of registered nursing; BSN preferred
- EDUCATION AND EXPERIENCE: Minimum of three years of clinical nursing experience: Preferred
- LICENSES OR CERTIFICATIONS: BLS Certification following American Heart Association guidelines required (no other cards accepted)
- LICENSES OR CERTIFICATIONS: Certified Professional in Healthcare Quality (CPHQ) or Certification in Case Management (CCM): Preferred
- LICENSES OR CERTIFICATIONS: Current California RN license required
- QUALIFICATIONS: Able to organize and maintain good follow-up
- QUALIFICATIONS: Able to work independently with minimal supervision
- QUALIFICATIONS: Excellent human relations and oral/written communications skills
- QUALIFICATIONS: Knowledge of current utilization/ continuing care principles, techniques, and procedures
Physical Requirements/Work Environment/Use of Senses and Communications Skills
- ACCOMMODATIONS: The physical demands and work environment characteristics described here are representative of those an employee typically encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the key responsibilities and essential functions
- CONFIDENTIALITY: Employee must conform with all HIPAA and other confidentiality regulations as required by the job, department, or hospital
- EQUIPMENT USED: Cell phone and pager
- EQUIPMENT USED: General office equipment, including computer, printer, calculator, copy machine and other office equipment
- PHYSICAL REQUIREMENTS (b): This job requires frequent bending, squatting, kneeling, climbing, reaching above shoulders, sitting, walking inclines and declines, standing, talking, hearing, and performing repetitive hand motions. Vision requirements include close vision and the ability to adjust focus. The employee will occasionally pull, lift, transfer, or push a patient side to side, to a sitting position, to a standing position, or laterally. The employee must demonstrate a pull lift of 50 pounds from the floor.
- POTENTIAL EXPOSURE TO BLOOD & BODY FLUIDS: Category 2 for potential exposure to blood/body fluids. (Does not usually require the performance of procedures or other tasks in the work routine that involve exposure to blood, body fluids or tissues, but Category 2 tasks may require the unexpected performance of these procedures.)
Job Roles
RN, Care Manager (AHCL)
- Appropriately delegates tasks and duties when directing and coordinating health care team members, patient care and activities.
- Assures completion of utilization review and management, including quality review, and case review for all third party payors including Medicare and Medi-Cal.
- Collaborates with the patient, responsible party/caregiver, nurse and attending physician in discharge planning and case management.
- Conducts initial review early in acute care admission on the identified targeted patient population for appropriateness of hospitalization. Monitors appropriate LOS on acute unit for identified patient population. Assures patient movement to lower level of care in timely manner.
- Demonstrates awareness and sensitivity to patient/visitor rights, as identified within the institution, and functions as a patient advocate.
- Demonstrates self-directed learning and participation in continuing education to meet own professional development. Demonstrates an awareness of self responsibility and accountability for own professional growth and practice.
- Evaluates denials for payment and assists in appeal process.
- Evaluates effectiveness of self, care given by all health care team members, and contributions of systems, environment, and instrumentation in progression of patient toward desired outcomes. - Formulates a goal directed plan of care, based on determined nursing diagnoses and desired patient outcomes. Functions to establish priorities of patient care based on essential patient needs, age of patient and available unit resources of time, personnel, equipment and supplies.
- Gathers and analyzes data, makes recommendations, collaborates with other health care professionals, including Risk Management. Identifies trended problems and educates staff related to pertinent issues.
- Implements care in a knowledgeable, skillful, consistent and continuous manner. Identifies patient/visitor learning needs and implements appropriate measures to meet these.
- Maintains and meets expectations on time for all competencies, license, certifications and education requirements as outlined by local administration, Adventist Health (AH), The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), and all other regulatory agencies.
- Maintains the appropriate documentation of reviews performed, according to pre established criteria.
- Monitors and evaluates services and outcomes by assessing benefit value to cost, facilitating plan modification as needed, and assessing patient/resident satisfaction and compliance with unit guidelines and regulatory agencies.
- Participates actively in staff development activities for unit and nursing division personnel.
- Participates in development and attainment of unit goals. Participates in peer review, unit quality management and improvement activities, and standards development.
- Performs assessment/data collection in an ongoing and systematic manner, focusing on biophysical, psychosocial and cognitive status, considering the age of the patients served.
- Performs documentation duties on unit and in patient record, which are timely, accurate and concise.
- Performs efficiency in emergency situations, following established protocols, remaining calm, informing appropriate persons, and documenting events.
- Willingly performs other duties and innovations as assigned.
Job Requirements:
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.
About Us
Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.
