CASE MANAGER

Position Overview

Day – 10 Hour (United States of America) – This is a Stanford Health Care Tri‑Valley job.

A Brief Overview:
Reviews each assigned case for appropriateness of admission and level of care. Acquires authorizations for non‑elective admissions, continued stays, and post‑acute hospital needs. Assesses patient/family needs for additional resources throughout the hospital stay and communicates identified needs and resources given to all appropriate team members.

Acute medical/surgical patients including neonate, pediatric, adolescent, young adult, middle‑age, and geriatric.

• Reviews medical information on all assigned patients and provides clinical justification of the admission using hospital/industry approved criteria within one working day, including identification of the appropriate level of care.
• Collaborates with all healthcare team members to develop and implement treatment plans that support the patient‑centered plan of care for both individual patients and the service line.
• Acts as a consultant to the clinical team, service lines, and other departments regarding patient assessment and patient care and participates in program development and quality improvement initiatives.
• Communicates accurately with Supervisor, Financial Counselors, Contract Dept., and/or Patient Accounting for pertinent account information or service needs.
• Coordinates all aspects of a patient's admission/discharge or outpatient visit/follow‑up; performs utilization review activities, including review of patient charts for timeliness of services as well as appropriate utilization of services; and ensures optimum use of resources, service delivery, and compliance with external review agencies' requirements.
• Consistently manages denials and facilitates the appeals process while keeping the physician and appropriate departments briefed on denial and progress of appeal.
• Coordinates activities of high‑risk patients related to inpatient care goals and 30 days after discharge by home visits and phone calls.
• Determines appropriate discharge options and identifies medical/psychological/social conditions that may require additional therapeutic support/treatment and communicates this to the staff contact at the higher level of care facility.
• Educates, coaches, and promotes self‑management skills and patient adherence to treatment plan by utilizing appropriate education methods based on the individualized patient needs, abilities, preferences and readiness to learn with respect to cultural, social, or ethical considerations.
• Actively participates in daily Patient Rounds, attends staff meetings, and serves on hospital‑wide committees.
• Performs all duties and responsibilities in accordance with the C‑I‑CARE Standards of the Hospital.

Graduate from an accredited school of nursing. Require BSN. Preferred: 2–3 years acute care nursing experience.

• 2–3 years acute care nursing experience.
• 2–3 years Utilization Review acute care hospital experience.
• Ability to work independently and function effectively as a member of an interdisciplinary team.
• Basic computer skills.
• Strong communication and interpersonal skills.
• Strong advocacy and problem‑solving skills.
• Strong attention to detail.
• Knowledge of growth and development principles and ability to interpret data regarding patient status to identify needs and appropriate care.
• Knowledge of acute care in relation to safety, security and joint commission standards.

• Nursing/RN – Registered Nurse – State Licensure and/or Compact State Licensure (required).
• Current American Heart Association Certification for Basic Life Support for Healthcare Providers (required).
• ACM or CCM – Certified Case Manager (preferred).

Generally starting at $70.57 – $95.29 per hour. Salary determined by factors such as internal equity, experience, education, specialty and training.

Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non‑discrimination in all of its policies and practices, including the area of employment. SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, disability, or the perception of any of the above.

Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

SHC adheres to the C‑I‑CARE standards – foundation of patient‑centered interactions – to anticipate, guide, and coordinate the patient’s care experience.