Nurse, Care Management
- Full-time
Job Description
Summary
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JOB SUMMARY
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Responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients; develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, and identifies cost-effective protocols. Care Management provides Care Coordination, Compliance, Transition Coordination, and Utilization Management.
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DUTIES & ESSENTIAL JOB FUNCTIONS
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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.
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- Coordinates all utilization review functions, including response to payor requests for concurrent and retrospective review information including Medicare and MediCal regulations / requirements, avoidable days and quality issues. Applies Medical necessity criteria to determine level of care.
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QUALIFICATIONS
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Required Education : Associate Degree in Nursing
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Preferred Education : Bachelor’s of Nursing
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Preferred Education : Master’s in Nursing
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Required Experience : Three years of acute care nursing
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Preferred Experience : Medical / surgical or critical care experience; broad clinical background. Within the last 3 years, experience in Case Management in an acute setting or utilization review at a medical group or health plan.
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Required Licenses / Certifications : Active licensure as a Registered Nurse in the State of California, Active 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; CPI -Crisis Prevention Intervention Training (required for all positions at John George Psychiatric Pavilion; and certain positions in the Emergency Department).
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Preferred Licenses / Certifications : Certification in Case Management, CCMC or ACM. Bilingual Preferred.
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PAY RANGE
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$77.67 to $113.98 per hour
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The pay range for this position reflects the base pay scale for the role at Alameda Health System. Final compensation will be determined based on several factors, including but not limited to a candidate’s experience, education, skills, licenses and certifications, departmental equity, applicable collective bargaining agreements, and the operational needs of the organization. Alameda Health System also offers eligible positions a generous comprehensive benefits program.
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Highland General Hospital
HGH Care Coordination
Full Time
Day
Care Management
FTE : 1
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