San Mateo Medical Center is currently seeking a full-time 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 idealcandidate will possess one or more of the following:
At least two years of recent, direct, and proven experience in Nurse Case Management in an acute care setting or at least two years of acute care hospital nursing experience
At least two years of 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
Licensure/Certification: Possession of a California license as a Registered Nurse.
Education and Experience:
Associate Degree in Nursing with two years of 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
Master's Degree in Nursing.
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.