Job Title: Case Manager - Critical Need **M-F 3pm-11:30pm Schedule Job Description The Case Manager works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and continued stays. They make recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for inpatient hospitalization. The Case Manager interacts with the family, patient, and other disciplines to coordinate a safe and acceptable discharge plan. This role functions as an indirect caregiver, patient advocate, and manages patients in the most cost-effective way without compromising quality. They transfer stable non-members to planned healthcare facilities and comply with AB 1203, Post Stabilization notification, and other duties as described. The Case Manager must be able to work collaboratively with the multidisciplinary team, multitask, and perform well in a fast-paced environment. Responsibilities + Plan, develop, assess, and evaluate care provided to members. + Collaborate with physicians, other members of the multidisciplinary health care team, and patient/family in the development, implementation, and documentation of appropriate, individualized plans of care to ensure continuity, quality, and appropriate resource use. + Recommend alternative levels of care and ensure compliance with federal, state, and local requirements. + Assess high-risk patients in need of post-hospital care planning. + Develop and coordinate the implementation of a discharge plan to meet patients' identified needs. + Communicate the discharge plan to physicians, patient, family/caregivers, staff, and appropriate community agencies. + Review, monitor, evaluate, and coordinate the patients' hospital stay to ensure that all appropriate and essential services are delivered timely and efficiently. + Participate in the Bed Huddles and carry out recommendations congruent with the patients' needs. + Coordinate the interdisciplinary approach to providing continuity of care, including Utilization Management, Transfer Coordination, Discharge Planning, and obtaining all authorizations/approvals as needed for outside services for patients/families. + Conduct daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient, and non-KFH facilities. + Act as a liaison between in-patient facility and referral facilities/agencies and provide case management to patients referred. + Refer patients to community resources to meet post-hospital needs. + Coordinate transfer of patients to appropriate facilities and maintain and provide required documentation. + Adhere to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA, and DOL. + Educate members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources. + Provide patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness. + Per established protocols, report any incidence of unusual occurrences related to quality, risk, and/or patient safety which are identified during case review or other activities. + Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources and participate in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities. + Coordinate, participate, and/or facilitate care planning rounds and patient family conferences as needed. + Participate in committees, teams, or other work projects/duties as assigned. Essential Skills + Two (2) years combined RN experience in an acute care setting or case management. + Completion of an accredited RN training program that allows graduates to take RN license exam. + Registered Nurse License (California). + Basic Life Support certification. + Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques, and methods of Utilization review/management, discharge planning, or case management. + Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.). + Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking, and problem-solving skills. + Demonstrated ability in planning, organizing, conflict resolution, and negotiating skills. + Computer literacy skills. Additional Skills & Qualifications + Experience in acute care, utilization management, and specialty RN roles. Work Environment The Case Manager will work collaboratively within a multidisciplinary team in a fast-paced environment. They will utilize various technologies and equipment to ensure the efficient and effective management of patient care. The role requires adherence to regulatory and accreditation standards and involves interaction with patients, families, healthcare staff, and community agencies to coordinate care plans. The position may involve participation in committees and other work projects as assigned. Pay and Benefits The pay range for this position is $65.00 - $72.00 • Medical, dental & vision• Critical Illness, Accident, and Hospital• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available• Life Insurance (Voluntary Life & AD&D for the employee and dependents)• Short and long-term disability• Health Spending Account (HSA)• Transportation benefits• Employee Assistance Program• Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully onsite position in San Diego,CA. Application Deadline This position will be accepting applications until Dec 27, 2024. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through: + Hiring diverse talent + Maintaining an inclusive environment through persistent self-reflection + Building a culture of care, engagement, and recognition with clear outcomes + Ensuring growth opportunities for our people The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.