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RN Case Manager (non patient facing)
Rancho Cordova, CA 95670
RN Case Manager
Working with complex cases promotes the delivery of quality; cost-effective health care services based on medical necessity and contractual benefits. Works with other members of HCS team, provider, hospitals, IPA/MGs, members and their families to plan and review medical necessity, intensity of services, level of care, length of stay and general appropriateness of care. Provides guidance to the provider network. Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care. May provide case management to member segments with chronic or catastrophic illness. Specific licensing requirements may apply depending upon position i.e. LVN or RN. Establishes operational objectives for department or functional area and participates with other managers to establish group objectives.
Responsible for team(s), department(s) or functional area(s) results in terms of planning, cost and methods
Develops and implements annual budget.
Ensures work flow procedures and guidelines are clearly documented and communicated.
Interprets or may initiate changes in guidelines/policies/procedures.
May lead special projects/committees/task forces.
- Generally requires Bachelor’s degree or equivalent work experience and extensive experience in Nursing, Health Care Administration or related field.
- Directs and controls the activities of a large department or several more complex smaller departments or functional areas through subordinate supervisors or managers. Has full management responsibility for staff (i.e. salary actions, promotions, performance reviews, and disciplinary matters) in accordance with the organization’s policies and applicable laws.
- Monitors on-going performance and communicates expectations and results.
- Provides developmental and training opportunities for team members.
- Identifies staffing needs and objectives.
- Great telephone skills
- Stable work history
- UM/CM experience
- Acute care experience
- CM certification
- CA RN license