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Clinical Nurse II, Care Management

Company: Alameda Health System
Location: San Francisco
Posted on: January 14, 2018

Job Description:

JOB SUMMARY: Under general direction, works in collaboration with physicians, staff, social work and other disciplines to assure the appropriate admit status and medical necessity for admission, securing the appropriate documentation and planning for continuing care. Identifies care issues and conveys barriers to discharge to appropriate disciplines while intervening to assure progression in the medical and nursing plan of care. Performs related duties as required. DUTIES & ESSENTIAL JOB FUNCTIONS NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

  • Assures clinical interventions are appropriate for the admitting diagnosis and reflect the standard of care, as defined by the medical staff and the organization.
    • Collaborates with the physician, staff and multidisciplinary team; reviews all admits for appropriate admit status based on identified criteria and ensures the patient is registered at the appropriate level of care.
      • Communicates with physicians and multidisciplinary health team members to provide continuity of care, supporting and maintaining the multidisciplinary team approach to ensure effective resource utilization.
        • Consulting with physicians and staff, actively participates in discharge planning rounds. Documents as needed in the patient medical record.
          • During the initial review, screens for discharge needs, making the appropriate referrals to ensure a safe transition to a post acute level of care.
            • Embraces best practice and core measures initiatives, assisting the staff in assuring appropriate care and teaching is achieved.
              • Initiates action and communicates with insurance agencies as well as authorizing county reimbursement for uninsured patients.
                • Initiates Treatment Authorization Record as needed, for services supplies and equipment, referring to departmental lead, those requiring a contract for service.
                  • Issues denial letters in accordance with the policy, as appropriate to specific payer.
                  • Maintains current knowledge of clinical practice and Case Management/Utilization Review activities by literature review, membership in a professional organization, continuing education related to specialty or pursuing certification.
                    • Makes appropriate referrals to homecare specialists or social work when discharge needs are identified.
                      • Monitors care provided making suggestions to achieve optimal outcomes, based on evidence based best practice.
                        • Participates in outcome data monitoring and audits as needed.
                        • Performs concurrent reviews assigning acute, administrative and denied days, and refers for a secondary review when necessary.
                          • Refers appropriate cases to the Director of Care Management or to the Physician Advisor for review, as appropriate.
                            • Utilizes clinical knowledge and defined standards of care to proactively identify inappropriate resource consumption and discuss with attending physician. MINIMUM QUALIFICATIONS: Education: Graduate of an accredited Nursing Program required; Bachelor's degree in Nursing preferred. Minimum Experience: Previous Case Management or Utilization Review experience in a clinical setting required. Minimum Experience: Two to five years recent clinical experience. Required Licenses/Certifications: BLS - Basic Life Support Certification issued by the American Heart Association. Other advanced life support certifications may be required per unit/department specialty according to patient care policies. Required Licenses/Certifications: CPI -Crisis Prevention Intervention Training (required for all positions at John George Psychiatric Pavilion; and certain positions in the Emergency Department). Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.

                              Keywords: Alameda Health System, San Francisco, Clinical Nurse II, Care Management, Healthcare, San Francisco, California

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