San Mateo Medical Center is currently seeking one Full-Time Extra Help Case Management Nurse to focus on Utilization Review and Discharge Planning.
At San Mateo Medical Center, we are always seeking ways to enhance the already impressive services we offer. This dedication to excellence is reflected in the exceptional care we provide and the extraordinary professionals who provide it. Here, you will have the chance to develop your talents with a skilled team of people who actively support and encourage each other's success. If you are ready to open new doors for your career, join us today!
The Case Management Nurse will manage patient admission and ongoing stay reviews for patients with chronic or complicated medical conditions; work closely with patients and their loved ones and interdisciplinary team to evaluate patients' needs and come up with a comprehensive discharge plan that speaks to their preferences and goals; oversee appeals with third-party payors; and initiate and coordinate complex discharge plans. The incumbent will be responsible for retrospective and concurrent Utilization Review activities and for monitoring documentation, accuracy, and clinical compliance, in accordance with State and Federal regulations. In conjunction with other members of the health care team, the Case Management Nurse is accountable for timely coordination of quality health care services to meet the patient's health care needs across the continuum of care. This position requires knowledge of the development stages, as services are provided to infant, children, adolescent, pediatric, adult, and geriatric populations.
The ideal candidate will possess one or more of the following:
- At least six months of recent, direct, and proven experience in Nurse Case Management in an acute care setting.
- Experience with industry published standards of level of care (i.e. InterQual or Milliman, etc.).
- A Basic Life Support (BLS) certificate.
- Experience working with diverse, underserved populations.
NOTE: The eligible list generated from this recruitment may be used to fill future extra-help, term, unclassified, and regular classified vacancies.
Examples Of Duties:
Duties may include, but are not limited to, the following:
- Identify problem situations or patient care issues; analyze, interpret, advise and consult with staff and other health care professionals to provide high quality, contemporary care.
- Interpret and modify the system of patient care delivered by evaluating and reviewing standard practices and initiating new procedures.
- Provide consultation and guidance to all levels of the nursing staff pertinent to patient care problems within the field of specialty.
- Advise the nursing staff in the establishment and maintenance of records of treatments given and the related progress of each patient for the purpose of analyzing patterns, synthesizing actions and evaluating patient care plans.
- Resolve unusual or unique patient care problems or situations, which require analytical, interpretative and constructive thinking.
- Formulate and develop plans, procedures and program content designed to meet specifically identified training/educational needs of nursing staff.
- Conduct formal classroom instruction in the more difficult or complex areas of nursing technology requiring a knowledge and understanding of the scientific principles and theoretical concepts underlying specific nursing procedures or techniques.
- Formulate, and/or collaborate with other health care practitioners to identify relevant clinical problems and conduct research to bring about their resolution.
- Communicate research findings by publication and presentation at professional meetings.
- Evaluate nursing research literature and own research findings for implementation and incorporation as appropriate, into patient care activities.
- Prepare formal and informal descriptive articles in the specialty area for publication in national periodicals or for use in staff meetings.
- Serve as role model and resource person for staff and members of the interdisciplinary team.
- Perform related duties as assigned.
Knowledge of: Advanced principles and practices in specialty areas; Nurse Practice Act; current nursing and related medical theory and skills necessary to administer nursing care within assigned clinical setting; safety and infection control practices; clinical systems, supplies and equipment; modern principles, techniques, and procedures of nursing; medical terminology; use and maintenance of medical instruments and equipment; use and effects of medicines; public health principles; health promotion and disease prevention; medical research principles and practices; principles of training and education; Lean principles and methodologies; data abstraction and utilization; basic statistics for reporting purposes; report writing; and regulatory and accreditation requirements for assigned area.
Skill/Ability to: Provide leadership and direction to multi-disciplinary medical teams; give direction to staff; evaluate the work of others; develop and present training and continuing education programs; design, evaluate, construct and modify research models; carry out research and present findings; perform the full range of nursing duties and responsibilities; prepare clear and concise medical record documentation; write articles for publication on areas of specialty; identify problems or discrepancies and make suggestions for corrective actions; teach and orient staff; establish and maintain effective working relationship with patients and staff members; and communicate effectively.
Education and Experience:
- Associate Degree in Nursing with two years clinical experience including one year in a clinical specialty area, or
- Baccalaureate Degree in Nursing or a health related field with one year of clinical experience including six months in a clinical specialty area, or
- Masters degree in Nursing.
Licensure/Certification: Possession of a California license as a Registered Nurse.
Additional Qualifications for Restricted Positions:
Specific qualifications are required beyond those specified above for the assignments listed below.
Case Management Nurse - Must have knowledge of and verifiable experience in initiating and coordinating complex discharge plans, appeals for acute days and clinical denials and criteria for lower level license care. Must have experience with interpretation and application of health industry utilization review criteria. If designated for acute in-patient psychiatry, must have knowledge and verifiable experience in psychiatric patient treatment trajectory and the respective utilization review criteria.
Open and Promotional. Anyone may apply. Current San Mateo County and San Mateo County Superior Court employees with at least six months (1040 hours) of continuous service in a classified regular, probationary, SEIU or AFSCME represented extra-help/term position prior to the final filing date will receive five points added to their final passing score on this examination.
Responses to the supplemental questions must be submitted in addition to our regular employment application form. A resume will not be accepted as a substitute for the required employment application and supplemental questionnaire.
The examination process will consist of an application screening (pass/fail) based on the candidate's application and responses to the supplemental questions. Candidates who pass the application screening will be invited to a panel interview (weight: 100%). Depending on the number of applicants, an application appraisal of education and experience may be used in place of other examinations, or further evaluation of work experience may be conducted to group applicants by level of qualification. Applicants who meet the minimum qualifications are not guaranteed advancement through any subsequent phase of the examination. All examinations will be given in San Mateo County, California, and applicants must participate at their own expense.
IMPORTANT: Applications for this position will only be accepted online. If you are currently on the County's website, you may click the "Apply Online" button above or below. If you are not on the County's website, please go to http://jobs.smcgov.org/ to apply. Online applications must be received by the Human Resources Department before midnight on the final filing date.
This is a continuous recruitment which may close at any time. The final filing date will be posted five days in advance on this job announcement.
Apply immediately. This recruitment is open on a continuous basis and selections may be made at any time within the process.
County of San Mateo is an Equal Opportunity Employer