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Legacy Personnel
Registered Nurse Care Manager
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Job Description
RN Care Coordinator / Case Manager - Acute Care Job Summary The RN Care Coordinator / Case Manager is responsible for coordinating care and services for assigned patients throughout an episode of illness or treatment. The Care Coordinator collaborates with patients, families, physicians, the multidisciplinary patient care team, and payors to facilitate high-quality, cost-effective patient care. The Care Coordinator utilizes advanced clinical nursing skills and the nursing process—including assessment, planning, intervention, and evaluation—to promote optimal clinical outcomes and effective resource utilization. This role serves as a patient and family advocate, supports communication among healthcare providers, and ensures appropriate care coordination throughout the patient's episode of care. The Care Coordinator may also be assigned to the Emergency Department and will work collaboratively with the multidisciplinary team to ensure efficient and effective management of the emergency episode of care. Key Responsibilities Coordinate care and services for assigned patients in collaboration with patients, families, physicians, the patient care team, and payors. Apply advanced clinical knowledge and nursing process principles to assess, plan, implement, and evaluate patient care. Promote effective utilization of healthcare resources through current clinical knowledge and awareness of community services. Assume a leadership role within the patient care team to achieve optimal clinical and resource outcomes. Evaluate and analyze quality and utilization cases, including admission and discharge criteria. Review observation and 1-day stays, 30-day readmissions, Medicare criteria, and diagnosis-related criteria. Participate in ongoing outlier review. Support care coordination activities in the Emergency Department, as assigned. Collaborate with physicians, payors, patients, families, and the multidisciplinary team to facilitate efficient and cost-effective care. Advocate for patients and families throughout the entire episode of care. Maintain availability to patients and families as a resource for communication and care coordination. Monitor services rendered and facilitate communication among healthcare providers. Remain involved in the patient's care until discharge, appropriate transfer to an acute care setting, or transition to an alternate level of care. Initiate appropriate clinical pathways based on the admission diagnosis. Serve as a resource for utilization management purposes. Promote continuity of care and appropriate resource utilization throughout the patient care episode. Minimum Requirements Minimum of 1 year of recent Case Management experience in an acute care setting . Current and active California RN license. Current BLS / certification AHA Clinical experience in an acute care hospital environment. Ability to collaborate effectively with physicians, nurses, payors, patients, and multidisciplinary care teams. Working knowledge of utilization management, admission and discharge criteria, and care coordination principles. Preferred Qualifications Experience with hospital-based utilization review and case management. Familiarity with Medicare criteria and diagnosis-related criteria. Experience with observation stays, 1-day stays, and 30-day readmission review. Knowledge of clinical pathways and resource utilization. Experience using EPIC electronic medical records. Strong communication, clinical assessment, organizational, and patient advocacy skills.