RN Case Manager - Care Coordination - Full Time 8 Hours Day (7:30 AM to 4:00 PM) (Union, Non-Exempt)

Keck Medicine of USC

23h•$50 - $77

About The Position

The Case Manager supports physicians and the interdisciplinary team in providing patient care, with the objectives of improving clinical outcomes and patient satisfaction, managing care costs, and providing payers with timely and accurate information. The position integrates and coordinates utilization management, care facilitation, and discharge planning. The Case Manager is accountable for a designated patient caseload and plans care to meet patient needs, manage length of stay, and promote efficient use of resources. The role includes facilitating pre-certification and payer authorization, coordinating patient care across the continuum, and addressing barriers to timely and efficient care delivery and reimbursement. It also involves applying process-improvement methodologies to evaluate care outcomes, supporting and coaching clinical documentation efforts, serving as a clinical resource for coders, ensuring documentation accurately reflects severity of illness and intensity of service, and coordinating communication with physicians.

Requirements

Associate’s degree in Nursing.
Registered Nurse (RN) certification from the California Board of Registered Nursing.
Basic Life Support (BLS) Healthcare Provider certification from the American Heart Association.
Workplace Violence Training Program.
Ability to work independently and exercise sound judgment when interacting with physicians, payers, patients, and their families.
Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
Excellent interpersonal communication and negotiation skills.
Strong organizational and time-management skills, including the ability to prioritize multiple tasks and role components.
Understanding of pre-acute and post-acute care venues and post-acute community resources.
Strong analytical, data-management, and PC skills.

Nice To Haves

Bachelor’s degree in Nursing.
Three years of clinical experience in utilization review and discharge planning in an acute hospital.

Responsibilities

Support physicians and the interdisciplinary team in providing patient care and improving clinical outcomes and patient satisfaction.
Manage the cost of care and provide payers with timely and accurate information.
Coordinate utilization management, care facilitation, and discharge planning.
Manage a designated patient caseload, planning to meet patient needs, manage length of stay, and use resources efficiently.
Facilitate pre-certification and payer authorization processes.
Facilitate collaborative management of patient care across the continuum.
Intervene to remove barriers to timely and efficient care delivery and reimbursement.
Apply process-improvement methodologies to evaluate outcomes of care.
Support and coach clinical documentation efforts and serve as a clinical resource for coders.
Ensure documentation accurately reflects severity of illness and intensity of service.
Coordinate communication with physicians.