Lead RN Case Manager

Salary Range: $55.26 - $76.15

Pay rates are determined based on experience and internal equity.

Position Summary:

• Reports to the Manager or Director of Case Management.

• Organize and report utilization management activities for BOP patients through the LVCHO.

• Organize and report utilization management and social service activities at the Acute hospital.

• Organize and report clinical documentation improvement/integrity for Acute hospital.

District Responsibility:

• Support the Lompoc Valley Medical Center mission and values

• Demonstrate Respect, Professionalism and Courtesy to all patients, visitors, other providers and coworkers, as delineated in the LVMC “Commitment to Care.”

• Constantly use C-I-CARE principles when communicating with others.

• Demonstrate commitment to the quality philosophy and values of Lompoc Valley Medical Center by maintaining established policies and procedures, organizational objectives, continuous quality improvement, quality assessment and safety standards

• Participate in performance Improvement Activities

• Participate in professional Development

• Participate in civic volunteer programs/organizations

• Demonstrate performance consistent with Case Management/Social services mission, philosophy, and goals for the district; remaining flexible to changing ideas; demonstrating efficiency and effectiveness in work habits

• Practice within Case Management Society of America’s Standards of practice for Case Management

Position Duties/Responsibility:

• Organize and report Case management, utilization review, clinical documentation data to help strategize current and future needs of Lompoc Valley Medical Center.

• Maintain standards focused on minimizing LOS and maximizing reimbursement while maintaining superior quality of care.

• Reviews medical records to ensure documentation is clear, complete, and accurate.

• Works collaboratively with physician staff to clarify information or add missing documentation to ensure accurate coding and quality reporting.

• Works to educate physicians on documentation for disease severity and treatment complexity.

• Ensure that proper staffing resources are identified, recruited, and trained to maintain the highest level of service.

• Create and nurture excellent and highly credible user and affiliated relationships with particular emphasis on superior service.

• Fulfill all roles of the RN Case Manager when needs arise.

• Other duties assigned by supervisor.

Essential Functions:

• The ability to meet all functions noted on the job description

• The ability to function unsupervised

• The ability to be supervised.

• Must work well under stress or tight deadlines.

• The ability to work as a Team.

• The ability to have positive personal interactions with staff, patients/residents and visitors.

• Must work well with supervisors, co-workers, patients/residents, family members and visitors.

Position Qualifications:

• Education: Bachelors or Masters degree in health administration or related field, preferred.

• Experience: Two years clinical acute hospital experience and utilization or Case Management other managed care experience is highly desirable.

• Certifications: Must have current California RN license, and BLS. Case management certification (CCM) preferred, CDI Certification (CCDS) preferred.

• Skills/Ability: Working knowledge of managed care requirements, discharge planning and hospital information systems highly desirable. Demonstration of knowledge about current utilization management principles, third party payor review requirements, age-specific principles, discharge planning process, community resources, and title 22 requirements for Social Services. Excellent verbal and written communication skills are essential. Exhibits the ability to organize work assignments and follow through with accuracy. Exercises good judgment, safe practice, demonstrates initiative, tact and poise.

• LVMC reserves the right to modify the minimum requirements depending on the needs of the organization.