RN Case Manager - Value Based Service Organization - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Keck Medicine of USC•Los Angeles, CA

35d•$53 - $87

About The Position

In collaboration with the interdisciplinary team, the Case Manager provides care coordination services evaluating options and services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care team in the management of specific patient populations. The role integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of post-hospital care services, including transfers to an alternative level of care. As more complex medical treatment options emerge the Case Manager will look to eliminate gaps in the care provided, as well as needlessly duplicated treatment, all while controlling the cost of quality patient care. The Case Manager will leverage their clinical and social work experience to ring an understanding of the clinical process of assessment, planning, implementation, and evaluation to the process of case management. Some of the major duties of a Case Manager include: Documenting patients' case management plans and on-going activities; Identifying patients 'insurance coverage or other sources of payment for services; Identifying and addressing patient risk factors and/or obstacles to care; Identifying patient needs, current services, and available resources, then connecting the patient to services and resources to meet established goals; Communicating the care preferences of patients, serving as their advocate, and verifying that interventions meet the patient's needs and treatment goals; Screening patients and/or population for healthcare needs; Developing a patient-focused case management plan; and Educating the patient/family/caregiver about the case management process and evaluating their understanding of the process. Some of the major duties of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate patient status is assigned upon admission and prior to discharge; InterQual or MCG reviews are completed within 24 hours of admission; Observation patients are effectively care managed on a daily basis; and Facilitate throughput and timely discharges throughout inpatient level of care.

Requirements

Associate’s Degree Nursing
5 years Clinical experience
2 years Ambulatory case management or utilization review experience within the last three years
Ability to work independently with minimal supervision, exercising judgment and initiative.
Ability to manage multiple tasks with effective prioritization.
Process oriented.
Good computer skills.
Registered Nurse - RN (CA DCA)
Basic Life Support (BLS) Healthcare Provider from American Heart Association
Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only).