RN Care Manager - Gastroenterology

Children's Hospital of Orange County•Orange, CA

11d•Onsite

About The Position

The RN Care Manager is responsible for delivering care coordination services to patients in a clinic setting. The role participates in planning and delivering family-centered care through collaboration with patients and families, nurses, social workers, physicians, other practitioners, caregivers, and community partners. It requires excellent verbal and written communication and coordination of care across the continuum. The RN advocates for patients, supports access to appropriate care and resources, and provides nursing care to help meet patients’ and families’ comprehensive needs. The position is eligible for CCS paneling to provide collaborative, comprehensive care in a multidisciplinary setting. The role applies strong clinical knowledge and nursing expertise to complex pediatric and specialty populations. The RN engages patients, families, providers, payers, community agencies, and interdisciplinary team members; navigates complex healthcare systems and managed care requirements; and uses leadership and critical-thinking skills to support care planning, problem-solving, care coordination practices, and quality outcomes. The position promotes equitable access, seamless transitions, and patient- and family-centered care. Experience with medically complex patients, gastrointestinal conditions, or gastroenterology specialty practices is preferred. The position is based in Orange, California, and works a day shift of eight hours. The listed pay range is $52.93 to $87.32 per hour, with rate determined by factors including knowledge, skills, competencies, experience, education, and position requirements. Physical demands include light to moderate energy, lifting and carrying 25–35 pounds, and pushing or pulling 50–100 pounds. The role involves the listed physical activities, sensory requirements, and exposure to environmental conditions and hazards.

Requirements

At least two years of nursing experience in pediatric care or an ambulatory setting.
Bachelor’s degree in nursing from an accredited university.
Basic Life Support (BLS) certification.
California Registered Nurse (RN) licensure.
Ability to work effectively under pressure with changing priorities, interruptions, census fluctuations, payer demands, and discharge-planning demands.
Excellent interpersonal communication, conflict-resolution, problem-solving, and negotiation skills.
Clinical knowledge of multiple age groups, medical illnesses, treatment plans, disease processes, diagnoses, and anticipated lengths of stay.
Strong organizational and time-management skills, including the ability to multitask and prioritize.
Ability to work independently and exercise sound judgment when interacting with physicians, payers, patients, and families.
Ability to communicate with third-party payers to obtain authorization for appropriate treatment settings, including medical, psychiatric, and chemical-dependency treatment.
Ability to complete required competencies during orientation and maintain annual departmental competency requirements.
Ability to collaborate with people regardless of social, economic, or cultural background.
Computer skills, including Microsoft Office applications: Excel, Word, PowerPoint, and Access.

Nice To Haves

Three or more years of nursing experience in an emergency department and/or in case management, care coordination, or transition of care; previous pediatric experience and/or management or charge nurse experience is acceptable.
Master’s degree in nursing from an accredited university.
Certification in Case Management.
Knowledge of CCS/Medi-Cal regulations and requirements.
Knowledge of third-party payer requirements to optimize reimbursement.
Ability to apply pediatric severity-of-illness and intensity-of-service criteria to information extracted from clinical documentation.
Bilingual ability.
Certified Pediatric Nurse (CPN) certification.
Certified Case Manager (CCM) certification.
Commission for Case Manager Certification (CCMC) certification.
Pediatric Advanced Life Support (PALS) certification.
Experience coordinating care for medically complex patients, including patients with gastrointestinal conditions or in gastroenterology specialty practices.
Experience navigating managed care, chronic disease management, multidisciplinary care models, and community resources.

Responsibilities

Deliver care coordination services for patients in the clinic setting.
Participate in planning and delivering family-centered patient care in collaboration with patients, families, nurses, social workers, physicians, other practitioners, caregivers, and community partners.
Communicate effectively in writing and verbally and facilitate care across the continuum.
Advocate for patients and assist them in achieving optimal health, accessing care, and using appropriate resources.
Provide nursing care and help meet the comprehensive care needs of patients and their families.
Coordinate care for complex pediatric and specialty populations and support care planning, problem-solving, transitions, and quality outcomes.
Collaborate with patients, families, providers, payers, community agencies, and interdisciplinary team members.
Navigate managed care requirements and healthcare systems while supporting equitable access to care.
Obtain payer authorization for appropriate treatment settings and support discharge planning.
Use clinical documentation and pediatric criteria to support appropriate care coordination and treatment setting decisions.