RN Case Manager - Utilization Review
About The Position
St. Francis Medical Center is a comprehensive healthcare institution in Los Angeles that provides diagnostic and treatment services across numerous specialties, along with community education and outreach programs. The hospital is designated as a Comprehensive Stroke Center, STEMI Receiving Center, ED Approved for Pediatrics, Geriatric ED, Level III Neonatal ICU, and Level II Trauma Center. The RN Case Manager is responsible for the quality and resource management of patients admitted to the facility, from admission throughout the continuum of healthcare management. The role advocates for patients while promoting cost containment and integrating healthcare providers to support seamless care delivery. The position performs holistic, comprehensive admission and concurrent medical-record reviews to assess medical necessity, intensity of service, and severity of illness, with the goal of achieving quality, clinical, and cost-effective outcomes.
Requirements
- At least five years of work experience after graduation from an accredited school of nursing.
- Current state Registered Nurse license.
- At least one year of experience in case management, discharge planning, or nursing management.
- Basic to intermediate computer skills and knowledge.
Nice To Haves
- Five years of acute care nursing experience.
- Certified Case Manager (CCM) certification, or ability to obtain it within one year.
- Knowledge of Milliman Criteria and InterQual Criteria.
- Current BCLS certificate.
Responsibilities
- Manage the quality and resources of patients admitted to the facility from admission throughout the continuum of healthcare management.
- Advocate on behalf of patients while promoting cost containment.
- Demonstrate leadership in integrating healthcare providers to support seamless delivery of care.
- Conduct holistic and comprehensive admission and concurrent reviews of medical records for medical necessity, intensity of service, and severity of illness.
- Support quality, clinical, and cost-effective outcomes.
Benefits
- Paid time off.
- 401K retirement plan.
- Medical coverage.
- Dental coverage.
- Vision coverage.
- Tuition reimbursement.
- Additional voluntary benefit options.
- Competitive compensation.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
