Job Summary:  Assists the Director, Care Management in leading and managing facility wide utilization management, coordination of care and discharge planning; manages enhanced ED disposition to the continuum during peak ED visit hours, performs UR/QI studies and interacts with department directors, physician advisors and department leaders as applicable to affect change and improve care and services. 

DUTIES & ESSENTIAL JOB FUNCTIONS: 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.

1.  Serves as leadership point person for escalating complex patient placement cases to local/system leadership and assure stakeholders are updated on continuum resources, afterhours processes, strategic partners, etc.

2.  Works with Utilization Chief, Hospitalist, and ED MD leaders to build/sustain relationships with vendor partners and develop solutions for common barriers in placing patients in the Continuum of care.

3.  Evaluates, plans, and executes changes in department procedures, equipment, and supplies.
In collaboration with System Educator, provides in-house Care Management educational programs as needed for both staff and physicians.

4.  Resolves operating and discipline problems; consult with supervisor and medical staff in resolving complaints.

5.  Establishes and maintains a method of tracking variances based on critical timelines.

6.  Conducts interdepartmental team conferences for identifying aberrant utilization.

7.  Develops and provides statistical UM information and reports to appropriate committees and in conjunction with the Director of Care Management identifies utilization issues affecting the quality of patient care.

8.  Regularly reports to the VP Administrative Services, and/or Director of Case Management regarding outcome metrics.

9.  Prepares statistical, cost analysis reports and other data needed for the preparation of the departmental budget.

10. Directs and coordinates data gathering and record keeping legally required by Federal and State agencies, the Joint Commission, and hospital policies. 

11. Assists Director in establishing, implementing and ensuring that care management policies, practices and procedures are in accordance with the Joint Commission, Title 22 and other regulatory agencies and overall hospital policies.

12. Plans, organizes, evaluates, and directs the work of a group of technical and clerical personnel.

13. Coordinates patient cases between Case Managers, Social Workers, Physicians, ED staff, and Post Acute Care Team as needed for timely placement and enhanced patient disposition.

14. Facilitates dispositions for patient cases alongside the Emergency Department Clinical Team and Case Managers.

15. Performs other duties as assigned.

Qualifications:

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

Required Education: BSN or graduate from an accredited Nursing program.

Preferred Education: Master's degree in nursing, health care, public administration, or business administration

Required Experience: Minimum five (5) years of nursing experience in patient care, preferably in the ED or ICU; Emergency or Critical Care clinical experience to partner with physicians and clinical teams to assess complex cases and advocate/make recommendations for disposition based on the patient presentation.

Preferred Experience: One year management experience in Case Management.

Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. BLS
 

$55.23- $92.04/hr

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, licensure 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.