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Salary Range: $50.70 - $69.87

Pay rates are determined based on experience and internal equity.

Position Summary

+ Reports to the Director of Case Management

+ Plan, organize and deliver utilization management activities for BOP patients through the LVCHO including authorization of services

+ Deliver utilization management services and social service activities within the acute hospital.

+ Assist patients with discharge planning and transfer to appropriate levels of care to meet their needs within the hospital or to an appropriate out of hospital setting .

District Responsibility:

+ Support the Lompoc Healthcare District 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 Healthcare District 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

+ 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:

+ Plan, organize and deliver utilization management activities for BOP patients through the LVCHO including authorization of services

+ Deliver utilization management services and social service activities within the acute hospital.

+ Assist patients with discharge planning and transfer to appropriate levels of care to meet their needs within the hospital or to an appropriate out of hospital setting

+ Assist with developing and maintain policies and standards focused on minimizing LOS and maximizing reimbursement while maintain superior quality of care.

+ Determines appropriate level of care based on CMS and Interqual guidelines.

+ Assists with educating and providing guidance to physicians through clinical documentation improvement activities.

+ Assist with educating and providing guidance to all District staff and physicians in the area of utilization of resources, appropriate level of care, and identification and reporting of mandated reporting issues.

+ Assist with educating and providing guidance to all District staff and physicians in the area of social service resources available.

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

+ 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: Current California license as Registered Nurse. Bachelors in nursing degree preferred.

+ Experience: A minimum of two years of clinical experience in Utilization Review or Case Management is preferred.

+ Per Diem Positions: Case Management experience with a minimum of 1 year is required.

+ Certification: Must have current BLS. Case management certification is preferred.

+ Skills/Ability: Working knowledge of managed care requirements, discharge planning and hospital information systems required. Must demonstrate knowledge of 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.