RN Case Manager - Full Time, Days (Culver City) - 10034
About The Position
The RN Case Manager performs clinical assessments and reassessments of acute-care inpatients for utilization review, resource management, and safe discharge planning. The role prioritizes, plans, organizes, and implements timely care, collaborating with the interdisciplinary healthcare team to coordinate safe, cost-effective patient care and transitions. The RN Case Manager advocates for patient self-determination and choice, practices with respect for patient and family diversity, monitors resource utilization across the continuum of care, and evaluates the timeliness of services. Admission, continued-stay, and discharge reviews are completed using medical staff-approved decision-support criteria. The RN Case Manager works with patients, families, community and healthcare resources, payers, and other stakeholders to coordinate appropriate transfers, discharges, and transitions of care. The position identifies post-hospital needs, arranges services and referrals, reviews medical necessity and level of care, documents utilization review, and escalates unresolved coordination issues. The role also collaborates on discharge planning, communicates with medical staff, participates in patient and family meetings, and contributes data to the Utilization Management Committee.
Requirements
- At least one year of case management experience or one year of nursing leadership experience.
- Current Registered Nurse licensure in the State of California.
- In-depth knowledge and strong understanding of patient throughput, care coordination, and care planning processes.
- Ability to assess medical stability for discharge and evaluate medical necessity for continued acute hospitalization.
- Computer, EMR proficiency, and literacy.
- Knowledge of CMS, Medicare, Medi-Cal, and Managed Care reimbursement.
- Familiarity with Joint Commission, CMS, and CDPH requirements.
- Excellent written and verbal communication skills in English.
- Ability to establish and maintain effective working relationships across the organization.
- Ability to facilitate and lead interdisciplinary rounds.
Nice To Haves
- Bachelor of Science in Nursing.
- Certified Case Manager (CCM).
- Acute hospital case management experience.
- Familiarity with AllScripts Care Management.
- Proficiency with Milliman Care Guidelines or InterQual.
- Bilingual skills to communicate effectively with patients and families.
Responsibilities
- Assess and reassess acute-care inpatients for utilization review, resource management, and discharge planning.
- Prioritize, plan, organize, and implement timely care in collaboration with the interdisciplinary healthcare team.
- Coordinate appropriate patient transfers, discharges, and transitions of care with patients, families, healthcare stakeholders, and community resources.
- Identify appropriate lower levels of care and timely post-hospital needs, and arrange services and referrals.
- Review medical necessity, level of care, and length of stay using approved evidence-based decision-support criteria.
- Complete and document concurrent utilization reviews and provide them to payers as required.
- Escalate unresolved care-coordination issues and enter service delays and avoidable days related to payer length-of-stay variances.
- Communicate denials and physician-related utilization management practices to the immediate supervisor on the same day they are identified.
- Collaborate with patients and caregivers on goals consistent with physician treatment plans, resources, and patient choices.
- Complete and document discharge planning assessments and reassessments in the medical record in compliance with hospital policy and regulatory requirements.
- Provide instructions to discharge care coordinators as needed.
- Liaise with medical staff to support continuity and congruity of hospital services with the patient's plan of care.
- Participate in patient and family meetings, promote patient choice, and document informed decision-making.
- Apply knowledge of psychosocial and physical factors affecting functional status at discharge.
- Contribute requested data to the Utilization Management Committee.
Benefits
- $25,000 sign-on bonus for eligible full-time RN positions, paid in increments over 24 months to active employees in good standing. Eligibility requires one or more years of acute-care RN hospital experience; current Alta Hospital employees are not eligible, and former employees may not be eligible.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
