Case Manager, RN- Pre Access

HENRY MAYO NEWHALL MEMORIAL HOSPITAL • Santa Clarita, CA

3d • Onsite

About The Position

The RN Case Manager-Pre Access is responsible for screening, coordinating, and facilitating admission review of all acute patients. Working collaboratively with all interdisciplinary staff, facilitates admission and transfer of patients, ensure that each patient is admitted meeting established medical guidelines in collaboration with credentialed medical staff, assist with the coordination of patient transfers into the hospital, and communicates all requested and questionable admissions/transfers to the Director of Case Management, and/or Physician Advisor.

Requirements

• Excellent organizational skills and the ability to problem solve are essential
• Strong interpersonal skills, leadership, negotiation skills, good leadership talent
• Knowledge of the payer industry, resource management, reimbursement, and evidence-based clinical practice is essential
• Knowledge of State and Federal regulations; e.g. EMTALA, Medi-Cal, HMOs, etc.
• Understanding of Medicare, Medi-Cal and other Third Party Payer regulations
• Understanding of current utilization/quality management principles, techniques and procedures
• Current CA RN license
• Current BLS provider card
• Diploma, AA, BS in Nursing
• Two years as a Case Manager in an acute care setting or five years recent acute care nursing experience.
• Demonstrates strong interpersonal skills, leadership ability, negotiation skills, and knowledge of hospital operations.
• General knowledge of the payer industry, resource management, reimbursement, and evidence-based clinical practice is essential.
• Advanced experience utilizing InterQual required.

Nice To Haves

• Case Management certification preferred
• MS in Nursing preferred
• Experience in Critical Care setting preferred

Responsibilities

• Develops, maintains, and models professional, objective and value-oriented interpersonal skills.
• Continuously promotes a patient-centered philosophy.
• Maintains positive and proactive communication with patients, families, staff members, and physicians.
• Fosters team-building relationships
• Facilitates admission and transfer of patients.
• Ensures that each patient is admitted meeting established medical guidelines in collaboration with credentialed medical staff.
• Assists with the coordination of patient transfers into the hospital.
• Communicates all requested and questionable admissions/transfers to the Director of Case Management, and/or Physician Advisor.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree