Case Manager, RN

3 weeks ago

Gardena, United States Memorial Hospital of Gardena Full time
Job DescriptionJob Description

We’re Here for Our Communities.

With four hospitals in Los Angeles, California, we are focused on providing the care and service our communities deserve – including 24/7 emergency care.

Our staff, physicians and corporate leaders share a commitment to empower those in our communities to live the healthiest lives possible. Our patients are a diverse population living in underserved areas – individuals and families who come to us for quality care delivered with compassion. We believe every individual deserves just that.

We understand the impact we have on our neighbors and our potential to improve the overall health of the communities we serve. In a recent survey of employees across our Pipeline Health organization, employees told us that the work they do is meaningful to them. Survey respondents gave this statement an average score of 4.6 on a scale of 1-5, with 5 being “strongly agree.”

Inside our hospitals, our dedicated teams enjoy a family-like work environment as we serve our patients together. Employee engagement is a high priority as we are working to ensure that we have a work environment that employees enjoy, an environment where they can succeed.

Furthermore, our values define who we aspire to be. They guide us each and every day.

• Passion

• Innovation

• Compassion

• Integrity

• Resilience

Our Pipeline Health family of hospitals includes:

• Memorial Hospital of Gardena (CA)

• Coast Plaza Hospital (Norwalk, CA)

• Community Hospital of Huntington Park (CA)

• East Los Angeles Doctors Hospital (CA)

Each of our Pipeline hospitals is proud to boast a number of awards and accreditations for critical services. Working together, our Los Angeles hospitals have created a successful Patient Hub – a transfer center that moves eligible patients from other hospitals to available beds in our hospitals for quality care.

Job Summary:
The RN Case Manager (CM) performs a wide variety of tasks and functions. These include utilization review, discharge planning, care coordination and variance management to assure the delivery of necessary services, efficient patient progression, and payment for the services provided.

  • Serves as a liaison between the designated Avanti Hospital and payers to ensure financial coverage for the patient.
  • Coordinates resources and services for the patient/family in response to individual needs and fiscal responsibilities.
  • Works with the multidisciplinary team to ensure coordination of patient care and wise utilization of resources.
  • Documents case management activities in the patient record and in the required information system.
  • The RN CM reports to the Director/Manager of the department.

Essential Job Duties:

  • Applies appropriate clinical knowledge in order to identify patient needs and effectively communicate medical necessity and treatment plan to payers.
  • Reviews concurrently and retrospectively all inpatients for appropriateness of admission, level of care, and length of stay utilizing InterQual criteria.
  • Collaborates with the multidisciplinary team to develop, coordinate, implement and evaluate patient care.
  • Identifies and anticipates discharge needs and collaborates with the multidisciplinary team to ensure that each patient’s discharge needs are assessed, planned for, and addressed in a timely manner.
  • Educates and collaborates with the multidisciplinary team including physicians and patients/families regarding utilization issues, documentation of medical necessity, discharge options, and community resources.
  • Anticipates barriers to efficient and effective patient progression by identifying clinical, operational, financial and social issues affecting patient outcomes and intervening to address these issues.
  • Estimates the expected length of stay (ELOS) based on the knowledge of patient cases and interactions with the interdisciplinary team. Communicates expected discharges to the unit charge nurse, patient unit and family.
  • Identifies patients at risk for extended lengths of stay, readmission, and complex discharge needs.
  • Identifies and documents Avoidable Days using the data to address opportunities for improvement.
  • Prevents denials and disputes by communicating with payers and documenting relevant information.
  • Promotes prudent utilization of all resources (fiscal, human, environmental, equipment, and services) by evaluating resources available to the patient and balancing cost and quality to assure optimal clinical and financial outcomes.

Behavioral Standards:

  • Exhibits customer and service-oriented behaviors in everyday work interactions.
  • Demonstrates a courteous and respectful attitude to internal workforce and external customers.

Communication/Knowledge:

  • Time management and priority setting skills.
  • Must have the ability to manage multiple complex activities with tight deadlines.
  • Ability to design, develop, and implement programs and care coordination with initiative and creativity.
  • Skilled in working with a wide range of personalities and utilizes sound judgment in working with all members of the team, patients/families, and payer representatives.
  • Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal patient care outcomes.
  • Professional dress and demeanor.
  • Able to remain poised under stress.
  • Able to use IT systems in an accurate and proficient manner.

Collaboration/Teamwork:

  • Contributes toward effective, positive working relationships with internal and external colleagues.
  • Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.
  • Education/Experience:
  • Bachelor’s degree in nursing preferred, Master prepared a plus.
  • Minimum of 2-3 years in Case Management Acute Care setting

Licensure/Certifications:

  • Current RN licensed in good standing by the California Board of Nursing
  • Current BLS for Health Care Provider card.
  • Accredited Case Manager (ACM) or Certified Cas

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