Saddleback Memorial’s centers of excellence are renowned for prevention, diagnosis and treatment of cancer, heart disease, stroke, pulmonary disease, orthopedics and diabetes; and for leadership in emergency medicine, critical care medicine, breast health, outpatient rehabilitation, advanced imaging, women’s health, geriatric care and surgery, including robotic-assisted procedures.
Saddleback Memorial Medical Center has consistently been named one of Healthgrades’ America’s 50 Best Hospitals, an achievement gained by just 1% of the nation’s hospitals. It has also been honored among Truven Health Analytics’ Top 50 Cardiovascular Hospitals in the U.S., consecutively voted Orange County’s #1 Best Hospital in the Orange County Register’s Best of Orange County poll of readers and has appeared on both Becker’s Hospital Review and Thomson Reuters’ lists of America’s Best Hospitals. Saddleback Memorial’s U.S. News & World Report “high-performance” ranking categories included Heart Failure, Hip Replacement, Knee Replacement and Chronic Obstructive Pulmonary Disease.
Position Summary: The Registered Nurse (RN) Case Manager collaborates with other professional disciplines/unit leaders to ensure safe and effective patient care delivery and the achievement of desired patient outcomes. She / he will be collaborating closely with ED and Admitting Physicians to ensure approprate admission status and supportive documentation. The Case Manager facilitates the coordination of the patients' care from pre-admission through hospitalization, to post-discharge follow-up, in collaboration with the healthcare team, to best meet the patients' physical, emotional, and spiritual needs. The RN Case Manager uses a problem-solving process that includes assessment, problem identification, goal definition, plan development, evaluation, reassessment and plan revision, and documentation in the patient record to achieve optimum patient outcomes on both an individual and population basis. The RN Case Manager concurrently educates the physicians (where appropriate) to substantiate documentation of diagnoses and to facilitate correct DRG and APR-DRG coding which adequately reflect the severity and projected risk of mortality for each patient according to their clinical condition.
* Three to five years of acute hospital experience in clinical areas and specifically in area of specialization, with working knowledge of utilization review, discharge planning activities, government and managed care regulations, quality improvement principles and risk management. * Computers, Internet, order entry and word processing experience preferred. * Ability to perform accurate chart review, analysis and data collection. * Clinical experience with for the ability to assess for the delivery of appropriate, evidence based medical care focused on quality and patient safety. * Collaborative interaction and effective education skills to facilitate discussions with medical staff, coders, and other healthcare team members. * Milliman Care Guideline and ED expertise is desireable.
Education/License/Certification: * Bachelor degree or higher in Nursing or a healthcare related field is preferred. * RN License required. * Current BLS for Healthcare Providers Certification. * Case Management Certificate or Certification preferred. * Clinical Documentation Specialist training in DRG assignment and the APR/DRG system preferred.