Case Management Nurse (Open)
San Mateo Medical Center is currently seeking one Full-Time Extra Help Case Management Nurse to focus on Utilization Review and Discharge Planning.
At San Mateo Medical Center, we are always seeking ways to enhance the already impressive services we offer. This dedication to excellence is reflected in the exceptional care we provide and the extraordinary professionals who provide it. Here, you will have the chance to develop your talents with a skilled team of people who actively support and encourage each other's success. If you are ready to open new doors for your career, join us today!
The Case Management Nurse will manage patient admission and ongoing stay reviews for patients with chronic or complicated medical conditions; work closely with patients and their loved ones and interdisciplinary team to evaluate patients' needs and come up with a comprehensive discharge plan that speaks to their preferences and goals; oversee appeals with third-party payors; and initiate and coordinate complex discharge plans. The incumbent will be responsible for retrospective and concurrent Utilization Review activities and for monitoring documentation, accuracy, and clinical compliance, in accordance with State and Federal regulations. In conjunction with other members of the health care team, the Case Management Nurse is accountable for timely coordination of quality health care services to meet the patient's health care needs across the continuum of care. This position requires knowledge of the development stages, as services are provided to infant, children, adolescent, pediatric, adult, and geriatric populations.
The ideal candidate will possess one or more of the following:
- At least six months of recent, direct, and proven experience in Nurse Case Management in an acute care setting.
- Experience with industry published standards of level of care (i.e. InterQual or Milliman, etc.).
- A Basic Life Support (BLS) certificate.
- Experience working with diverse, underserved populations.
NOTE: This list will be used for extra-help hire only. This is an extra-help, at-will assignment, paid on an hourly basis. Some extra help positions are eligible for benefits under the Affordable Care Act. Extra help employees are not guaranteed permanent status at the end of the assignment.
- Examples Of Duties
Duties may include, but are not limited to, the following:
- Identify problem situations or patient care issues; analyze, interpret, advise and consult with staff and other health care professionals to provide high quality, contemporary care.
- Interpret and modify the system of patient care delivered by evaluating and reviewing standard practices and initiating new procedures.
- Provide consultation and guidance to all levels of the nursing staff pertinent to patient care problems within the field of specialty.
- Advise the nursing staff in the establishment and maintenance of records of treatments given and the related progress of each patient for the purpose of analyzing patterns, synthesizing actions and evaluating patient care plans.
- Resolve unusual or unique patient care problems or situations, which require analytical, interpretative and constructive thinking.
- Formulate and develop plans, procedures and program content designed to meet specifically identified training/educational needs of nursing staff.
- Conduct formal classroom instruction in the more difficult or complex areas of nursing technology requiring a knowledge and understanding of the scientific principles and theoretical concepts underlying specific nursing procedures or techniques.
- Formulate, and/or collaborate with other health care practitioners to identify relevant clinical problems and conduct research to bring about their resolution.
- Communicate research findings by publication and presentation at professional meetings.
- Evaluate nursing research literature and own research findings for implementation and incorporation as appropriate, into patient care activities.
- Prepare formal and informal descriptive articles in the specialty area for publication in national periodicals or for use in staff meetings.
- Serve as role model and resource person for staff and members of the interdisciplinary team.
- Perform related duties as assigned.
Knowledge of: Advanced principles and practices in specialty areas; Nurse Practice Act; current nursing and related medical theory and skills necessary to administer nursing care within assigned clinical setting; safety and infection control practices; clinical systems, supplies and equipment; modern principles, techniques, and procedures of nursing; medical terminology; use and maintenance of medical instruments and equipment; use and effects of medicines; public health principles; health promotion and disease prevention; medical research principles and practices; principles of training and education; Lean principles and methodologies; data abstraction and utilization; basic statistics for reporting purposes; report writing; and regulatory and accreditation requirements for assigned area.
Skill/Ability to: Provide leadership and direction to multi-disciplinary medical teams; give direction to staff; evaluate the work of others; develop and present training and continuing education programs; design, evaluate, construct and modify research models; carry out research and present findings; perform the full range of nursing duties and responsibilities; prepare clear and concise medical record documentation; write articles for publication on areas of specialty; identify problems or discrepancies and make suggestions for corrective actions; teach and orient staff; establish and maintain effective working relationship with patients and staff members; and communicate effectively.
Education and Experience:
- Associate Degree in Nursing with two years clinical experience including one year in a clinical specialty area, or
- Baccalaureate Degree in Nursing or a health related field with one year of clinical experience including six months in a clinical specialty area, or
- Masters degree in Nursing.
Licensure/Certification: Possession of a California license as a Registered Nurse.
Additional Qualifications for Restricted Positions:
Specific qualifications are required beyond those specified above for the assignments listed below.
Case Management Nurse - Must have knowledge of and verifiable experience in initiating and coordinating complex discharge plans, appeals for acute days and clinical denials and criteria for lower level license care. Must have experience with interpretation and application of health industry utilization review criteria. If designated for acute in-patient psychiatry, must have knowledge and verifiable experience in psychiatric patient treatment trajectory and the respective utilization review criteria.
If you are interested in being considered for this extra help position, the following materials must be electronically submitted in a Word or PDF format.
Responses to these supplemental questions:
1. Possession of a current California license as a Registered Nurse is required to qualify for this recruitment. Do you possess a current California license as a Registered Nurse? (Please include your license number. A "No" answer will disqualify you from this recruitment.)
2. Describe your experience in Utilization Review/Discharge Planning as a Registered Nurse, specifically your experience in initiating and coordinating complex discharge plans, appeals for acute days and clinical denials and criteria for lower level license care, as well as your experience with interpretation and application of health industry utilization review criteria. Include your years of experience and where this experience was gained. Be specific.
3. Describe a time when you managed an admission and ongoing stay review for a patient with chronic or complicated medical conditions. Please include who you worked with and involved in your evaluation of the patient's needs to come up with a comprehensive discharge plan. Be specific.
4. Provide a few examples of times you have collaborated with other departments while working on new operational protocols, procedures and departmental tasks. Who did you collaborate with, what were the situations, and what were the outcomes? Be specific.
Please include the words "Case Management Nurse" in the subject line of email submission. All submitted materials must be in a Word or PDF format.
Please submit the above listed materials via email to:
David McGrew, Chief Financial Officer, San Mateo Medical Center
Apply immediately. Resumés will be accepted until the position is filled. This posting is open on a continuous basis and selection may be made at any time within the process.
Application materials will be reviewed as they are received and well-qualified candidates will be contacted for an interview.
NOTE: Application materials are only accepted via e-mail. Materials sent via regular mail and/or fax will not be accepted. Submittals that do not include all required elements (responses to supplemental questions, writing sample, graphic design sample(s) and a resume) will not be considered.
At the County of San Mateo, we take pride in the way our employees bring together their diverse backgrounds, experiences, and perspectives to serve our community's needs. The County is an Equal Employment Opportunity Employer.
Keywords: nurse, case manager, utilization review, discharge planning, discharge planner, InterQual, Quality Management, QA, clinical nurse