RN Case Manager

RN Case Manager - Loan Forgiveness - Full Time, Days (Culver City)

Culver City, CA, United States

JOB DESCRIPTION

The RN Case Manager is responsible for performing clinical assessment and reassessment of acute care Inpatients for the purpose of performing utilization review, resource management and safe discharge planning. The RN Case Manager prioritizes, plans, organizes, and implements timeliness of care. Collaborates with the interdisciplinary healthcare team to promote and coordinate the delivery of safe and cost-effective patient care, transition of care and discharge planning. The RN Case Manager advocates for patient self-determination and choice. Practices clinical competence in evaluations and planning with awareness and respect for patient and family diversity. Monitors and coordinates resource utilization throughout the continuum of care and evaluates timeliness of services. Performs admission, continued stay and discharge review utilizing medical staff-approved decision support criteria.

RESPONSIBILITIES

$25,000 Sign-on Bonus

Collaborates as needed with the patient and family to optimize client outcomes. May include work with community, local and state resources, primary care provider, and members of the health care team, payer, and other relevant health care stakeholders to facilitate appropriate patient transfers, discharges and transitions of care. Identifies timely and effective alternative lower level of care settings for patient care in accordance with the patient's medical necessity, stability, the patients' preferences and health plan benefits. Identifies timely post-hospital needs and arranges for services as appropriate. Provides patient and family appropriate resources and/or referrals. Makes timely and appropriate referrals to, and seeks consultation with others when needed, the patient-centered provision of services; such as Social Services (i.e., Durable Power of Attorney).

Reviews medical necessity utilizing medical staff-approved evidence-based decision support criteria. to determine appropriate level of care and length of stay. Ensures utilization review is completed and documented concurrently, and provided to the patient's payer as required. Ensures timely escalation of unresolved care coordination issues to the appropriate level. Enters delays in service and avoidable days regarding exceeded payer LOS variances. Communicates denials and physician related utilization management practices to immediate supervisor same day as identified.

Collaborates with patients/caregivers to set goals consistent with physician treatment plans, and patient resources and choices. Collaborates with the multidisciplinary team for timely discharge planning assessments and reassessments and documents concurrently in the patient's medical record in compliance with hospital policy and all regulatory agencies. Provides appropriate instructions to discharge care coordinators as needed.

Acts as an effective liaison to medical staff to ensure continuity and congruity of hospital services in accordance with the patient's plan of care.

Participates in patient and family meetings; respecting and promoting patient choice and documents informed decision making. Utilizes knowledge of psycho-social and physical factors that affect functional status on discharge.

Contributes requested data for the Utilization Management Committee.

QUALIFICATIONS

Southern Cali Hospital Culver City

Required Qualifications:

One year of case management experience or 1 year nursing leadership experience

Current Licensure as a Registered Nurse 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 of Joint Commission, CMS, 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

Preferred Qualifications:

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

Pay Rate: Min - $58.32 | Max - $82.48

$25,000 Sign-on Bonus

Sign-on Bonus Eligibility: To be eligible for the Sign-On Bonus, you must have one or more years of experience in the role for the position posted. Some restrictions and exceptions may apply. Current Hospital employees are not eligible and former Hospital employees may not be eligible. The Sign-on Bonus Program is only available for full-time regular positions. Bonus payments are made in increments over the course of 24 months to active employees in good standing.

ABOUT US

Southern California Hospital at Culver City has been taking care of generations of Culver City and west LA residents. We are a full-service, acute care hospital with a 24/7 emergency department and nationally recognized patient safety. Now at 420 beds, SCH-CC is a general acute care hospital that utilizes many of the latest medical treatments and technologies. The hospital offers a wide range of inpatient and outpatient acute care services, including an orthopedic center, cardiovascular services, acute rehabilitation, sub-acute care, psychiatric care and chemical dependency programs. Additionally, SCH-CC operates a 24-hour emergency services center, which serves as a paramedic receiving station and is staffed by board-certified emergency physicians and nurse specialists.

Union Pay Info: