Case Manager, RN

HENRY MAYO NEWHALL MEMORIAL HOSPITAL • Santa Clarita, CA

3d

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. Applies knowledge of the expected clinical process, available resources, medical necessity criteria, regulatory requirements, and relevant standards of care in anticipating patient needs. 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. 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
• Diploma, AA, BS in Nursing
• Two (2) 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.
• Develops, maintains, and models professional, objective and value-oriented interpersonal skills.
• Maintains positive and proactive communication with patients, families, staff members, and physicians.
• Excellent organizational skills and the ability to problem solve are essential
• Strong interpersonal skills, leadership, negotiation skills, good leadership talent
• Ability to work independently

Nice To Haves

• Case Management certification preferred
• MS in Nursing preferred
• Knowledge of InterQual and/or Milliman preferred
• Fosters team-building relationships

Responsibilities

• 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
• Overseeing coordination of post-hospital care needs
• Interacting with insurance companies, medical groups, and community resources to ensure timely, efficient use of all services
• Case management across the continuum of care utilizing an interdisciplinary approach to managing patient throughput in a fiscally responsible manner to achieve optimal outcomes
• Actively facilitate those functions associated with the patient throughout an acute episode of care

What This Job Offers

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