Case Manager, RN - Ambulatory Case Management

Cedars-Sinai•Beverly Hills, CA

6h•$48 - $77•Onsite

About The Position

This role is for a Case Manager, RN in Ambulatory Case Management at a world-class Medical Group known for the highest clinical standards and patient satisfaction. The position is available with one of the best places to work in Southern California. The Case Manager is responsible for the case management of patients while hospitalized and upon discharge from various care settings. In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the Case Manager will assist patients from admission until discharge by assessing their needs, coordinating care, communicating with health plans, and performing concurrent reviews to ensure quality and cost-effective care.

Requirements

Bachelor's Degree Graduate of an accredited school of nursing required
3 years nursing experience required
1-2 years of previous experience in case management in the outpatient setting required
Current California RN license required

Responsibilities

Meets with patients within 24 hours of admission and conducts an initial assessment.
Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patient’s stay.
Reviews with hospitalist the patient’s admission and continued stay for medical necessity, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary.
Plans for discharges and care assessments.
Submits necessary clinical information to the health plan using the accepted format (MIDAS or telephonic) and coordinate health plan communication with assigned hospitalist as appropriate.
Coordinates with nurse practitioner and case manager assigned to the SNF’s for continued review and follow up.
Communicates transition of care to the member or responsible party including: Transition process and what to expect, Changes in health status and the care plan, Staff who will be handling issues, questions, concerns, i.e. Case Manager.
Authorizes all appropriate services based upon covered benefits and necessity of care provided in the: Member’s home or residence, Acute Care, Skilled Nursing Facility, Rehabilitation Facility, Home Health Care, Custodial Care facility or Board and Care Facility.
Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate.
Secures outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers.
Refers to Ambulatory Case Manager for those patients identified that need oversight of outpatient care and compliance to avoid unnecessary readmissions.
Coordinate referrals and secure appointment with various CSMNS disease management programs.