Case Manager, RN

Henry Mayo Newhall Memorial Hospital • Santa Clarita, CA

82d

About The Position

The RN Case Manager is responsible for coordination of care, utilization review, acting as a resource to patient, family and nursing units; referrals to clinical social worker for psycho-social issues and complicated discharge planning issues; and overseeing coordination of post-hospital care needs. Interacting with insurance companies, medical groups, and community resources to ensure timely, efficient use of all services is a key part of the role. The RN Case Manager applies knowledge of the expected clinical process, available resources, medical necessity criteria, regulatory requirements, and relevant standards of care in anticipating patient needs. This position is responsible for case management across the continuum of care utilizing an interdisciplinary approach to managing patient throughput in a fiscally responsible manner to achieve optimal outcomes. The RN Case Manager works as a member of a multidisciplinary team to actively facilitate those functions associated with the patient throughout an acute episode of care.

Requirements

• Current CA RN license
• Current BLS provider card
• Two years as a Case Manager in an acute care setting or five years recent acute care nursing experience preferred.
• 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.
• Knowledge of InterQual and/or Milliman preferred.

Nice To Haves

• Case Management certification preferred
• MS in Nursing preferred.

Responsibilities

• Coordinate care and conduct utilization reviews.
• Act as a resource to patients, families, and nursing units.
• Refer patients to clinical social workers for psycho-social issues and complicated discharge planning.
• Oversee coordination of post-hospital care needs.
• Interact with insurance companies, medical groups, and community resources to ensure efficient service use.
• Apply knowledge of clinical processes and regulatory requirements to anticipate patient needs.
• Manage case management across the continuum of care using an interdisciplinary approach.
• Facilitate functions associated with patients during acute care episodes.

What This Job Offers

• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees