Inpatient Case Manager RN

7 days ago

Northridge, California, United States Heritage Provider Network Full time
Job Description

Position Summary:

The Inpatient Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode.

Assesses and develops a plan of care in collaboration with the admitting, attending and consultant physicians, and other healthcare practitioners. The goal of the Inpatient Case Manager is to effectively manage the patients during their hospitalization to assure the appropriate level of care is provided for the patients current severity of illness, utilizing the appropriate tests and diagnostics, in the appropriate facilities in order to provide the highest level of care, in the most efficient manner, while utilizing only the resources necessary for that episode of care. The Inpatient Case Manager is also responsible for developing a safe discharge plan and implementing the discharge plan for patients with the necessary resources to ensure that care is provided without interruption along the continuum of care, whether in a skilled nursing facility, assisted living facility, in the home setting, etc. The Inpatient Case Manager will plan, coordinate, and collaborate with internal departments to ensure the patient is receiving the best coordination of care. The Inpatient Case Manager will document based on regulatory and contractual guidelines established by Federal, State, Local and Health plan guidelines, along with policies and procedures established by the Medical Management department.

Essential Duties and Responsibilities include the following but are not limited to:
  • Perform clinical review upon admission and daily while patient is hospitalized
  • Assure appropriate level of inpatient care
  • Monitor inpatient stay to prevent delays in services and/or report aberrancys.
  • Identify and resolve barriers or potential barriers to safe transition and outpatient management.
  • Coordinate and assure all services for care transitions including transfer to lower levels of care,
  • transfer to outpatient management, etc.
  • Educate members on post discharge instructions, outpatient physician follow-up, appropriate
  • use of urgent care, and appropriate use of ER services.
  • Initiate and hand off case to Skilled Nursing Case Managers or Outpatient Management
  • Programs (i.e. Vital Care, Hospice, etc) as appropriate.
  • Timely response to member needs act in the moment.
  • Coordinate care for patients in the Emergency Room or Urgent Care to avoid an unnecessary actions.
  • Timely documentation based on regulatory and contractual guidelines established by Federal,
  • State, Local and Health plan guidelines, along with policies and procedures established by the
  • Medical Management department.
  • Creating and approving referrals for admissions and outpatient services based on Medical
  • Management guidelines.
  • Creating letters for patients based on regulatory and contractual guidelines established by
  • Federal, State, Local and Health plan guidelines, along with policies and procedures established
  • by the Medical Management department.
  • Uses, protects, and discloses patients protected health information (PHI) only in accordance
  • with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Consistently exhibits behavior and communication skills that demonstrate commitment to
  • superior customer service, including quality care and concern with each and every internal and
  • external customer.
  • Seek assistance and escalate issues when needed from the Administrator on call, or Regional
  • Medical Director on call for clinical oversight and decision making.
  • Participate in weekend rounds with Regional Medical Director and Hospitalists.
  • Perform other duties as assigned.
The pay range for this position at commencement of employment is expected to be between RNs $45.00-$50.00 per hour; LVNs $37.25-$40.00 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an at-will position and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Requirements

Education and/or Experience:
  • Graduate from an accredited Registered Nursing Program or Licensed Vocational NursingProgram.
  • Current California License
  • Knowledge of Healthcare and Managed Care preferred.
  • At least 2 years of clinical experience in the acute care setting.
  • Typing 40 words per minutes with accuracy.
  • Knowledge of computers, faxes, printers and all other equipment.
  • Knowledgeable in MS Office programs (i.e., Word, Excel, and Outlook).
  • Ability to handle confidential matters.

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