Job Description

Eastern Plumas Health Care is a small, non-profit, critical access hospital district, providing comprehensive medical services to Plumas County since 1971. We operate a 9 bed acute care hospital at our main Portola campus, which includes a 24 hour, physician staffed, emergency room and ambulance service. In addition, four primary care medical clinics and a dental clinic offer residents a full spectrum of health care services in the Graeagle, Loyalton, and Portola communities. There are also hospital-based Skilled Nursing Facilities in Portola and Loyalton.

The Case Manager/QA Coordinator is responsible for coordination of patient care impacting length of stay, minimizing cost and ensuring optimum outcomes.  Her/His responsibilities include implementing and monitoring quality assurance standards throughout the facility to ensure quality care to patients.This is a day shift, full time, benefited position. 

PRINCIPAL ACCOUNTABILITIES

  • Promote the mission, vision and values of the organization
  • Responsible for evaluating and screening potential admissions to the facility in collaboration with the Acute nursing staff
  • Facilitate team meetings that foster interdepartmental collaboration with the patient, their family as deemed necessary and all involved caregivers.  Provides input in such meetings regarding case management and discharge planning.
  • Communicate with physicians to ascertain their plans for a timely discharge.  Educates and provides guidance to physicians and staff regarding appropriate level of care/quality issues.
  • Knowledge of or willingness/ability to acquire knowledge of criteria for Medicare, Medical, HMO and private insurance coverage. Cooperates with insurance companies, based on information received.
  • Initiate ongoing communication with the patient and patient’s family to assess discharge needs. Knowledge of patient’s financial status, diagnosis and discharge needs.
  • Document discharge planning as an ongoing review.
  • Assist with obtaining referrals, prior authorizations for Home Health Care, Durable Medical Equipment, Skilled Nursing Care, Acute Rehab and/or follow up care/appointments with a goal of arrangements completed 24 hours prior to discharge when discharge date is known.
  • Reviews quality assurance standards, studies existing hospital policies and procedures, and interviews hospital personnel and patients to evaluate effectiveness of quality assurance program.
  • Writes needed quality assurance policies and procedures.
  • Reviews and evaluates patients' medical records, applying quality assurance criteria.
  • Selects specific quality topics for review. 
  • Collects and compiles statistical data from department heads on monthly quality reports and writes narrative reports summarizing, quality assurance findings.  Reports the findings to the Medical Executive Committee monthly and to the Board of Directors quarterly.
  • Coordinates, plans and retains appropriate documentation of Quality Committee meetings.
  • Oversees, as necessary, personnel engaged in quality assurance review of medical records.

 POSITION REQUIREMENTS

  • Current licensure as a Registered Nurse in the State of California.
  • Current BLS, ACLS & PALS
  • Dependability and maturity demonstrated by commitment to patient needs and by reliability to scheduled time.