Case Manager Utilization RN, 40/hr Day

4 days ago

Los Angeles, United States Recruitics JB Full time
Sign On Bonus for Eligible
Job Summary:

Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a safe and acceptable discharge plan. Functions as an indirect caregiver, patient advocate and manages patients in the most cost effective way without compromising quality. Transfers stable non-members to planned Health care facilities. Responsible for complying with AB 1203, Post Stabilization notification. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team, multitask and in a fast pace environment.



Essential Responsibilities:

  • Plans, develops, assesses and evaluates care provided to members.
  • Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use.
  • Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
  • Assesses high risk patients in need of post-hospital care planning.
  • Develops and coordinates the implementation of a discharge plan to meet patients identified needs.
  • Communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies.
  • Reviews, monitors, evaluates and coordinates the patients hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
  • Participates in the Bed Huddles and carries out recommendations congruent with the patients needs.
  • Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families.
  • Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient and non-KFH facilities.
  • Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
  • Refers patients to community resources to meet post hospital needs.
  • Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation.
  • Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA and DOL.
  • Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
  • Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
  • Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities.
  • Reviews, analyses and identifies utilization patterns and trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.
  • Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed.
  • Participates in committees, teams or other work projects/duties as assigned.

Basic Qualifications: Experience
  • Two (2) years combined RN experience in an acute care setting or case management required.
Education
  • Completion of an accredited RN training program that allows graduates to take RN license exam.
License, Certification, Registration
  • Registered Nurse License (California)
  • Basic Life Support
Additional Requirements:
  • Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management.
  • Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
  • Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills.
  • Demonstrated ability in planning, organizing, conflict resolution and negotiating skills.
  • Computer literacy skills required.
Preferred Qualifications:
  • Bachelors degree in nursing or healthcare related field.

  • Case Manager Utilization RN, 40/hr Day

    3 months ago

    Los Angeles, United States Kaiser Permanente Full time

    Sign On Bonus for Eligible External Hires Job Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family,...

  • Case Manager Utilization RN, 40/hr Day

    2 weeks ago

    Los Angeles, United States HealthEcareers - Client Full time

    Sign On Bonus for Eligible External Hires Job Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient...

  • Case Manager Utilization RN, 40/hr Day

    4 days ago

    Los Angeles, United States Recruitics JB Full time

    Sign On Bonus for Eligible External Hires Job Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient...

  • Case Manager Utilization RN, 40/hr Day

    3 days ago

    Los Angeles, United States Recruitics JB Full time

    Sign on Bonus for Eligible External Hires Job Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient...

  • Case Manager Utilization RN, 32/hr Day

    17 hours ago

    Los Angeles, United States Recruitics JB Full time

    Sign On Bonus for Eligible External Hires Job Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient...

  • Case Manager Utilization RN, 24/hr Mid-Shift

    2 months ago

    Los Angeles, United States Kaiser Permanente Full time

    Sign On Bonus for Eligible External Hires Job Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family,...

  • Case Manager Utilization RN, 24/hr Night ED

    5 hours ago

    Los Angeles, California, United States Recruitics JB Full time

    Job SummaryWe are seeking a skilled RN Case Manager to join our team at Recruitics JB. As a Utilization Case Manager, you will play a critical role in coordinating and screening patient admissions and continued stays, working collaboratively with physicians to ensure the most cost-effective care without compromising quality.Key ResponsibilitiesDevelop and...

  • Case Manager Utilization RN, 24/hr Night ED

    3 hours ago

    Los Angeles, California, United States Recruitics JB Full time

    Job SummaryWe are seeking a skilled RN Case Manager to join our team at Recruitics JB. As a Utilization Case Manager, you will play a critical role in coordinating and screening patient admissions and continued stays, working collaboratively with physicians to ensure the most cost-effective care without compromising quality.Key ResponsibilitiesDevelop and...

  • Case Manager Utilization RN

    2 weeks ago

    Los Angeles, California, United States Kaiser Permanente Full time

    Job SummaryKaiser Permanente is seeking a skilled Case Manager Utilization RN to join our team. As a key member of our healthcare team, you will play a critical role in coordinating and managing the care of our patients.Key ResponsibilitiesCollaborate with Physicians: Work closely with physicians to develop and implement individualized plans of care that...

  • Case Manager Utilization RN

    15 hours ago

    Los Angeles, California, United States Recruitics JB Full time

    Job Summary:We are seeking a skilled RN Utilization Case Manager to join our team at Recruitics JB. As a key member of our multidisciplinary team, you will work collaboratively with physicians to coordinate and screen for the appropriateness of admissions and continued stays. Your expertise will be essential in making recommendations to physicians for...

  • Travel Nurse RN Case Manager

    3 days ago

    Los Angeles, California, United States TotalMed Case Management Staffing Full time

    Job DetailsTotalMed Case Management Staffing is seeking a skilled travel nurse RN case manager to fill a challenging position in Tarzana, California.Job RequirementsSpecialty: Case ManagementDiscipline: RNDuration: 4 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelAbout TotalMed Case Management StaffingWe are a leading healthcare staffing...

  • Case Manager Utilization RN

    5 days ago

    Los Angeles, California, United States Kaiser Permanente Full time

    Job SummaryWe are seeking a skilled RN Case Manager Utilization Specialist to join our team at Kaiser Permanente. As a key member of our healthcare team, you will play a critical role in coordinating and managing patient care to ensure the highest quality outcomes.Key ResponsibilitiesCollaborate with physicians and other healthcare professionals to develop...

  • Travel Nurse RN Case Manager

    2 days ago

    Los Angeles, California, United States TotalMed Case Management Staffing Full time

    Job OpportunityTotalMed Case Management Staffing is seeking a skilled Case Manager-Registered Nurse for a travel nursing assignment in Los Angeles, California.Job RequirementsSpecialty: Case ManagementDiscipline: RN40 hours per weekShift: 8 hours, nightsEmployment Type: TravelWe are looking for a dedicated Case Manager-Registered Nurse to join our team in...

  • Case Manager Utilization RN, 24/hr Night ED

    4 days ago

    Los Angeles, United States Recruitics JB Full time

    Job Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a safe...

  • Case Manager Utilization RN, 24/hr Night ED

    2 days ago

    Los Angeles, United States Recruitics JB Full time

    Sign On Bonus for Eligible External Hires Job Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient...

  • Case Manager Utilization RN, 24/hr Mid-Shift

    4 days ago

    Los Angeles, United States Recruitics JB Full time

    Sign On Bonus for Eligible External HiresJob Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient...

  • Travel Nurse RN Case Manager

    3 days ago

    Los Angeles, California, United States TotalMed Case Management Staffing Full time

    Job DetailsTotalMed Case Management Staffing is seeking a skilled travel nurse RN case manager to join their team.About the JobSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelWe are looking for a dedicated and experienced case manager-registered nurse to work with our team in Los Angeles, California.TotalMed Case Management Staffing offers a...

  • Travel Nurse

    6 days ago

    Los Angeles, United States Epic Travel Staffing Full time

    Job DescriptionEpic Travel Staffing is hiring a Travel RN - Case ManagementShift: Days / 8a-4:30p, 8x5, 40 hrs per weekLength: 22 weeksRequirements:CA License2 years experienceBLSEpic Travel Staffing:Day 1 health insurance coverage and comprehensive benefits options401(k) matching programWeekly direct depositConcierge state licensing program for RN and other...

  • RN Case Manager

    5 days ago

    Los Alamos, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Case Managers in New Mexico   Come join our growing team! A few of our perks:Create your own schedule!$40/hr. (including 100% of Hourly Wage Paid for All Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with...

  • Traveling RN Case Manager

    3 weeks ago

    Los Angeles, California, United States GQR Healthcare-Allied Full time

    Position OverviewGQR Healthcare-Allied is currently in search of a dedicated travel nurse RN specializing in Case Management.Job DetailsSpecialty: Case ManagementDiscipline: RNDuration: 13 weeksWork Schedule: 40 hours per weekShift: 8 hours, including days and nightsEmployment Type: TravelQualifications: Minimum of 3 years clinical experience in NICU and 2...