Care Manager, Registered Nurse

EDUCATION:

• Graduate of an accredited school of nursing
• Bachelor's in Nursing preferred.

CERTIFICATION & LICENSURE:

• RN-Registered Nurse of California Upon Hire

TYPICAL EXPERIENCE:

• 2 years recent relevant experience.

SKILLS AND KNOWLEDGE:

• A broad knowledge base of health care delivery and case management within a managed care environment.
• Comprehensive knowledge of Utilization Review, levels of care, and observation status.
• Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems preferred.
• Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC.
• A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements.
• General understanding of coding and DRG assignment process preferred.
• Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.
• Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
• Demonstrates commitment to service excellence in all patients, family and employee interactions and in performing all job responsibilities.
• Functions in a manner to promote quality patient care and assure a positive patient experience.
• Strong verbal and written communication skills and negotiation skills
• Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
• Intermediate computer and technology skills.
• Ability to promote teamwork and to effectively function in teams.
• Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.