Case Manager

Loma Linda University Health • Murrieta, CA

5d

About The Position

The Case Manager is a key member of the patient care delivery team, working efficiently in a fast-paced environment and applying clinical expertise, discretion, and independent judgment to the nursing process—assessment, care planning, intervention, and evaluation—within a patient-centered professional practice model. The role applies specialized case and utilization management methodologies and practices to ensure medical necessity criteria are met and documented for the level of care from admission through discharge.

In a collaborative healthcare environment, the Case Manager oversees implementation of an interdisciplinary plan of care and an individualized discharge plan that addresses the patient’s continuing healthcare needs. The role reevaluates the plan as the patient’s needs and condition change, supports improvements in clinical practice and operations, and participates in committees, task forces, and staff meetings to contribute to clinical decision-making. Other duties may be assigned as needed.

Requirements

• Bachelor of Science in Nursing (BSN).
• At least two years of hospital nursing experience.
• Basic knowledge of case management and utilization management practices and methodologies, and state and federal healthcare regulations and accreditation requirements.
• Ability to speak, read, and write legibly in English with professional quality.
• Ability to use a computer, printer, and position-related software, including Microsoft Office Suite, Outlook, an electronic medical record, and an electronic event reporting program.
• Ability to communicate positively and effectively, behave professionally, 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, solve problems, recall information accurately, and pay close attention to detail.
• Sufficient hearing for general conversation in person and by telephone, ability to identify workplace sounds, and adequate vision to read computer screens, medical records, and written documents.
• Active and unrestricted California Registered Nurse (RN) license.
• Current Basic Life Support (BLS) certification issued by the American Heart Association.

Nice To Haves

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

Responsibilities

• Apply the nursing process to case management functions within a patient-centered care model.
• Apply case and utilization management methodologies and practices.
• Ensure medical appropriateness criteria are met and documented for the level of care from admission through discharge.
• 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.
• Support and participate in committees, task forces, and staff meetings that may influence clinical practice decisions.
• Promote and support change and improvements in the workforce, clinical practice, and operational setting.
• Perform other duties as needed.

What This Job Offers

• Job Type: Full-time