Los Robles Hospital & Medical Center is a licensed 404 bed acute care facility. Fully accredited by the Joint Commission, Los Robles Hospital has the only Level III Trauma Center in Eastern Ventura County and the only Emergency Room in both Los Angeles and Ventura counties coveted EDAP (Emergency Department Approved for Pediatrics) rating. In addition, it is the only hospital certified by both counties as a STEMI designated heart attack center for rapid heart attack response and is a certified Primary Stroke Center. With over 600 physicians on its medical staff, representing over 50 medical specialties, Los Robles is proud to be the community's most trusted resource for health and a regional destination for care.
The Case Management Manager (CMM) is a registered nurse with advanced training and experience in Case Management. This position reports to the Director of Case Management. The Case Management Manager is responsible and accountable for monitoring the case management process throughout the hospital utilizing the established case management process and tools, established policies and procedures, established professional standards, and administrative hospital-wide policies. The Case Management Manager proactively coordinates and implements all aspects of the Case Management program.
The overall goals of the position and department include, but are not necessarily limited
q Promoting efficiency of care & appropriate utilization of resources
q Assisting with patient flow through the continuum of care, including but not limited to bed management, placement of ED patients, assisting with evaluation of Direct Admits and monitoring and assisting with discharge planning.
q Identifying patient continuum of care needs and assuring these needs are met
q Monitoring, anticipating and controlling insurance denials in a concurrent and timely fashion.
q Obtaining optimal reimbursement for the Hospital
q Working with Nursing to help ensure patient satisfaction
q Promoting optimal ALOS and timely safe discharge plans
q Promoting positive relations with all continuum of care providers including but not limited to Physicians; Health plans; Payors; Patients / families; the healthcare team and all other customers
POSITION DUTIES AND RESPONSIBILITIES :
© Manages the day-to-day running of the department including but not limited to:
o Staffing, Attendance, Schedule, balancing case load
o Daily rounding on floors to interact with and support case managers
o Assist with evaluations
o Assist with KRONOS
o Gathering & analyzing data to help with process improvement
o Managing orientation of new employees
o Annual competencies
o Participates in progressive discipline process
o Increase efficiency of dept processes
o Stay abreast of regulatory and / or contractual agreements
o Assisting in implementing and educating staff and physicians re new processes resulting from changes instigated by governmental and non-governmental regulatory agencies.
o Other duties as assigned
© Works closely with the Director in planning for future changes and adaptations within the department.
Oversees: Implementation and documentation of the following:
© Timely Initial Review (within 24 hours of admission, 7 days per week)
© Patient/Family Interviews (eliciting sufficient information during initial review to begin development of discharge plan)
© ECIN InterQual (or Midas )
© Documentation in MediTech and elsewhere
© Physician admission orders written correctly per CMS; orders match the correct level of care
© Daily assessment of Observation patients for appropriateness of level of care
© Timely electronic referrals to Physician Assistant as needed
© Supports Case Managers in working with difficult physicians, families and patients
© Recognizes areas where more training or education is needed for members of the department, physicians or families and patients.
© With the Director of the department develops programs and processes to assist with training and education
REQUIRED KNOWLEDGE, ABILITIES AND LICENSING:
q Current CA RN license. BSN (BSN in progress is acceptable)
q Minimum 4 years acute care experience (Medical / Surgical, ICU or ED preferred)
q Minimum 3-5 years experience as a case manager, UR nurse or discharge planner
q Managerial experience
q Ability to work independently and responsibly without direct supervision
q Ability to interact effectively with medical staff, hospital personnel, patients / families (possesses interpersonal skills that reflect a positive attitude and a sense of commitment).
q Strong willingness to learn
q Ability to recognize and ask for help as needed
q Ability to identify problems, apply Root Cause Analysis, develop solutions and implement problem resolution
q Strong written & verbal communication skills
q Excellent computer skills required
o CERMe on line either ECIN or Midas
o Windows - Excel, Outlook, Word, Power Point
q Ability to be tactfully assertive / proactive in accomplishing job functions
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom