Case Manager - RN. Children's Hospital

Loma Linda University Health • Loma Linda, CA

3d • Onsite

About The Position

The Case Manager utilizes clinical expertise, discretion, and independent judgment to apply specialized case and utilization management methodologies and practices to ensure medical appropriateness criteria is met and level of care provided is documented. Serves as a resource to the Collaborative Practice Care Management Team (CPCM) to coordinate care, patient flow, and medically appropriate cost-effective quality healthcare. Identifies high risk financial, clinical, and social cases with potential negative impact and offers CPCM Team solutions and alternatives for care. Negotiates reimbursement with payer sources for unique and complex cases. Utilizes knowledge in the delivery of quality whole person care. Utilizes interpersonal skills that support excellence in customer service, safe patient care, and professionalism. Contributes to a work environment of caring and cooperation among a culturally diverse workforce and patient population. Performs other duties as needed.

Requirements

• Bachelor of Science degree in nursing (BSN) required.
• Minimum two years of hospital nursing experience required.
• Active and unrestricted California Registered Nurse (RN) license required.
• Current Basic Life Support (BLS) certification issued by the American Heart Association required.
• Able to read; write and speak with professional quality.
• Able to use computer and software programs necessary to the position, e.g., Word, Excel, Power Point, Access.
• Able to operate/troubleshoot basic office equipment required for the position.
• Able to relate and communicate positively, effectively, and professionally with others.
• Able to provide leadership.
• Able to be assertive and consistent in following and/or enforcing policies.
• Able to work calmly and respond courteously when under pressure.
• Able to lead, supervise, teach, and collaborate.
• Able to accept direction.
• Able to communicate effectively in English in person, in writing, and on the telephone.
• Able to think critically.
• Able to work independently with minimum supervision.
• Able to perform basic math and statistical functions.
• Able to manage multiple assignments effectively.
• Able to compose written material.
• Able to work well under pressure.
• Able to problem solve.
• Able to organize and prioritize workload.
• Able to recall information with accuracy.
• Able to pay close attention to detail.
• Able to distinguish colors as necessary.
• Able to hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace.
• Able to see adequately to read computer screens, and written documents necessary to the position.

Nice To Haves

• Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred.
• Working knowledge of regulatory requirements and accreditation standards preferred.
• Nationally recognized certification in Utilization Management or Case Management preferred.

Responsibilities

• Apply specialized case and utilization management methodologies and practices to ensure medical appropriateness criteria is met and level of care provided is documented.
• Coordinate care, patient flow, and medically appropriate cost-effective quality healthcare as a resource to the Collaborative Practice Care Management Team (CPCM).
• Identify high risk financial, clinical, and social cases with potential negative impact and offer CPCM Team solutions and alternatives for care.
• Negotiate reimbursement with payer sources for unique and complex cases.
• Utilize knowledge in the delivery of quality whole person care.
• Utilize interpersonal skills that support excellence in customer service, safe patient care, and professionalism.
• Contribute to a work environment of caring and cooperation among a culturally diverse workforce and patient population.
• Perform other duties as needed.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level