Case Manager Utilization Rn, 40/hr Day
3 weeks ago
**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 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**:
- 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.
**Notes**:
- Week 1: Sun,Tues,Wed,Thurs,Fri Week 2: Mon,Tues,Wed,Thurs,Sat
- Every other weekend
PrimaryLocation : California,Los Angeles,Los Angeles Medical Center
HoursPerWeek : 40
Shift : Day
Workdays : Sun, Mon, Tue, Wed, Thu, Fri, Sat
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 04:30 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employ
-
Case Manager Utilization Rn, 40/hr Day
1 month ago
Los Angeles, United States Kaiser Permanente 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...
-
Case Manager Utilization Rn, 24/hr Day
3 days 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 Day
4 hours ago
Los Angeles, United States Kaiser Permanente Full timeDescription: 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...
-
Case Manager Utilization Rn-per Diem Day
5 days ago
Los Angeles, United States Kaiser Permanente 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...
-
Rn Case Manager
4 weeks ago
Los Angeles, United States Universal HCR Full time**About us**: - **RN Case Manager - Bilingual** - **Location: Los Angeles, CA 90057** - **Job Type: Full Time Permanent** - **Shifts: Full-time (40 hrs/week)** - **Start Date: ASAP** - **Positions Available: 02** **Pay/Salary: $120,000 To $125,000 yearly + $15K sign on bonus.** **Key Essential Functions and Accountabilities of the Job**: - Serves as a...
-
Case Manager Utilization RN-Per Diem Night
3 weeks ago
Los Angeles, United States Kaiser Permanente Full timeDescription: 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...
-
Utilization Management Specialist
7 days ago
Los Angeles, United States Keck Medical Center of USC Full timeThe Utilization Management Specialist coordinates communication with admitting financial counselors, case management, patient financial services, and payers to ensure all inpatient services provided by the hospital are authorized by appropriate payer. The Utilization Management Specialist works with case managers to facilitate timely transmission of...
-
RN Case Manager
2 days ago
Los Angeles, California, United States University of Southern California (USC) Full timeIn collaboration with the interdisciplinary team, the RN Care Manager provides care coordination services evaluating options and services required to meet an individuals health care needs to promote quality outcomes. Serves as a consultant to members of the health care team in the management of specific patient populations. The RN Care Manager role...
-
Local Contract Nurse RN
7 hours ago
Los Angeles, United States Pyramid Consulting Full timePyramid Consulting is seeking a local contract nurse RN Case Management for a local contract nursing job in Los Angeles, California.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, days, evenings, nights, flexibleEmployment Type: Local ContractPerks: Employee benefits...
-
Case Manager Full Time Days
1 month ago
Los Angeles, United States Hollywood Presbyterian Full timeJob DescriptionJob DescriptionCHA Hollywood Presbyterian (CHA HPMC) is a nationally recognized acute care facility that has been caring for the Hollywood community and Los Angeles Areas since 1924.Join our Global Network and be a CHA Global Ambassador CHA HPMC is also a part of the world-renown CHA Health System (CHS). CHS has CHA University which consists...
-
Local Contract Nurse RN
2 weeks ago
Los Angeles, United States Pyramid Consulting Full timeJob DescriptionPyramid Consulting is seeking a local contract nurse RN Case Management for a local contract nursing job in Los Angeles, California.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: 05/15/2024Duration: 13 weeks40 hours per weekShift: 8 hours, days, evenings, nights, flexibleEmployment Type: Local ContractPerks:...
-
Local Contract Nurse RN
6 days ago
Los Angeles, United States Pyramid Consulting Full timeJob DescriptionPyramid Consulting is seeking a local contract nurse RN Case Management for a local contract nursing job in Los Angeles, California.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, days, evenings, nights, flexibleEmployment Type: Local ContractPerks:...
-
Case Manager- RN
1 week ago
West Los Angeles, CA, United States Rx relief Full timeJob: *Case Manager- RN - Rehab Hospital **Pay: $52-$60/ per hour -* *Depending on experience* Location: *West Los Angeles, CA * Schedule: Monday- Friday, 8:00am-5:00pm Full-Time, Temp-to-Hire, Direct hire Great benefits!! Including Medical, Rx, Vision, Dental, 401(k)*Case Manager- RN - Rehab Hospital Job Description:* Rx relief is seeking a *Case Manager-...
-
Local Contract Nurse RN
7 days ago
Los Angeles, United States Pyramid Consulting Full timeJob DescriptionPyramid Consulting is seeking a local contract nurse RN Utilization Review for a local contract nursing job in Los Angeles, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: ASAPDuration: 3 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Local ContractPerks: Contract to HireContract to...
-
Case Manager
2 days ago
Los Angeles, United States Recooty Full timeWe offer a quick turnaround after applying! Apply Online We will email you an assessment within 24 hrs Schedule you for an interview within 48 hrs after applying Extend an offer within 24 hrs or give you a free cup of coffee on us (Starbucks gift card) Why You’ll Love It Here Our culture of doing meaningful work with people you enjoy through supporting and...
-
Registered Nurse Case Manager
2 days ago
Los Angeles, United States A-Line Staffing Solutions Full timeJob DescriptionJob DescriptionA-Line Staffing is now hiring a Registered Nurse Case Manager with a California RN License The Registered Nurse Case Manager would be working for a Fortune 500 company and has career growth potential. This would be full time / 40+ hours per week.If you are interested in this position, please Apply to this Posting to Jon at...
-
Supervisor, Utilization Management RN
1 month ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2...
-
Supervisor, Utilization Management RN
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $102, Min.) - $132, Mid.) - $163, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Case Manager- RN
3 hours ago
West Los Angeles, CA, US Rx Relief Full timeJob: *Case Manager- RN - Rehab Hospital **Pay: $52-$60/ per hour -* *Depending on experience*Location: *West Los Angeles, CA *Schedule: Monday- Friday, 8:00am-5:00pmFull-Time, Temp-to-Hire, Direct hireGreat benefits!! Including Medical, Rx, Vision, Dental, 401(k)*Case Manager- RN - Rehab Hospital Job Description:*Rx relief is seeking a *Case Manager- RN -...
-
Case Manager
3 days ago
Los Angeles, United States San Pedro Convalescent Home, Inc Full timeJob DescriptionJob DescriptionPosition Summary: The LVN Case Manager is responsible for the coordination of the patient’s care and services. Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Works together with the patient and family, care team, payers, and external...
