Case Manager - RN

Job Summary

Under the general supervision of the CM Director, the nurse case manager manages clinical resource utilization and documentation affecting reimbursement, acting as a resource to staff and physicians in resource efficiencies and documentation that affects reimbursement. In this position the case manager provides a planned and systematic process for monitoring and evaluation of all patients, assessing the medical, financial, psychosocial, and physical needs in planning for discharge.

Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

• Reviews clinical information daily on each patient to determine if continued stay is clinically appropriate and, if not, discusses the discharge plan with the physician and team.
• Partners often throughout the shift with the Discharge Planning Assistant to direct the facilitation of transition/discharge plan, arranging post‑acute facility, DME, HH, etc. in a timely manner, preventing avoidable days.
• Attends daily HPIRounds to collaborate with members of the health care team in removing barriers to discharge and managing LOS.
• Communicates current patient status, level of care and LOS in huddles and HPIRounds.
• In conjunction with Social Work interviews patients/family within 24 hours (or earlier if needed) of admission to determine if the patient needs a discharge plan and initiates the discharge plan by completing the discharge planning assessment.
• Collaborates with other care team members and patient/family to create a safe and effective transition/discharge plan.
• Responds timely to case management consults for patients.
• Refers patients to SW in a consult as indicated.
• Confer with physician for clarification/change of status order when indicated, ensuring the status order change has been written in the EHR.
• Collaborate with CDI in determining the GMLOS to drive length of stay.
• Initiate referral to financial counseling for patients needing assistance.
• Complete Avoidable Days.
• Consult and work with medical staff, nursing, and ancillary staff regarding functional status and needs of the patient.
• Use clear, concise, professional communication with coworkers, patients, all customers internal and external.
• Use AIDET in interactions with patients and family members. Utilize white boards for patient communication.
• Collaborate across disciplines to assist in coordination of patient care, including but not limited to patient transfer, discharge, referrals, and spiritual/psychosocial support needs.
• Act with a sense of urgency when performing tasks.
• Maintain basic unit/department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
• Report any equipment and/or environmental issues for repair.
• Abide by HIPAA regulations.
• Utilize SBAR when communicating with physicians and health care team.
• Speak up to stop the line and escalates potential safety events if necessary.
• Complete and attend training as assigned.
• Other duties as assigned.

• Treats everyone as their customer; utilizes scripting and other tools to ensure consistency in customer service; expresses recognition and shows appreciation to others; fully utilizes AIDET principles; responds quickly to handle requests, complaints, and questions; displays a positive attitude.
• Demonstrates the highest level of professionalism, passion and care when interacting with patients, families, physicians, and hospital staff members.
• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential, embracing ingenuity to serve our customers.

• Wears nametag properly; follows dress code policy; answers phone correctly and…