Case Manager

Loma Linda University Health•Loma Linda, CA

2d•Onsite

About The Position

The Case Manager serves as a key member of the patient care delivery team at a large tertiary academic medical center with Magnet Recognition, Level I trauma designation, STEMI receiving center designation, and Comprehensive Stroke Center and Chest Pain Center accreditation. The role uses clinical expertise, discretion, and independent judgment to perform nursing-process functions—assessment, care planning, intervention, and evaluation—within a patient-centered professional practice model and in relation to case management responsibilities. The Case Manager applies case and utilization management methodologies, ensures medical necessity criteria are met and documented throughout the stay, and collaborates with the healthcare team to oversee an interdisciplinary plan of care and individualized discharge plan. The plan is reevaluated as the patient's needs and condition change. The role also supports nursing excellence and Magnet Recognition, embraces innovation and improvement, helps implement new processes, and participates in professional governance and other opportunities to influence bedside clinical practice. This is a full-time, onsite position, Monday through Friday, 8:00 a.m. to 4:30 p.m., with five eight-hour shifts. Weekend or holiday work may be required based on operational needs.

Requirements

Bachelor of Science in Nursing (BSN).
At least two years of hospital nursing experience.
Basic knowledge of case and utilization management practices and methodologies and state and federal healthcare regulations and accreditation.
Active, unrestricted California Registered Nurse (RN) license.
Current American Heart Association Basic Life Support (BLS) certification.
Ability to communicate legibly and professionally in English.
Ability to use computers, printers, and role-related software, including Microsoft Office Suite, Outlook, electronic medical records, and electronic event-reporting programs.
Ability to communicate and relate positively and effectively, maintain professional behavior, remain calm and courteous under pressure, follow policies consistently, teach and collaborate, accept direction, think critically, and work independently with minimal supervision.
Ability to perform basic math and statistical functions; manage multiple assignments; organize and prioritize workload; problem-solve; recall information accurately; and pay close attention to detail.
Sufficient hearing to converse in person and by telephone, distinguish workplace sounds, and vision adequate to read computer screens, medical records, and other required written documents.

Nice To Haves

At least two years of case management, utilization review, or discharge planning experience in an acute care environment.
Spanish language ability.
Nationally recognized certification in Utilization Management or Case Management.

Responsibilities

Perform nursing-process functions, including assessment, care planning, intervention, and evaluation, in relation to case management.
Apply case and utilization management methodologies and practices in daily work.
Ensure medical necessity criteria are met for the level of care provided and documented from admission through discharge.
Collaborate with the healthcare team to oversee implementation of an interdisciplinary plan of care and a comprehensive individualized discharge plan.
Reevaluate the plan of care and ensure it remains appropriate as the patient's needs and condition change.
Meet professional nursing expectations and nursing excellence standards to achieve and maintain Magnet Recognition.
Embrace new knowledge, innovations, and improvements; serve as a change agent and help minimize resistance to change.
Participate in professional governance councils, committees, taskforces, and staff meetings to influence bedside clinical practice.
Help implement new processes to achieve desired outcomes and performance measures.
Perform other duties as needed.