Case Manager Utilization RN, 24/hr Night ED

3 hours ago

Los Angeles, California, United States Recruitics JB Full time
Job Summary

We 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 Responsibilities
  • Develop and implement individualized plans of care to ensure continuity, quality, and appropriate resource use.
  • Collaborate with physicians, other healthcare team members, and patients/families to coordinate safe and acceptable discharge plans.
  • Assess high-risk patients in need of post-hospital care planning and develop coordinated discharge plans to meet their needs.
  • Communicate plans to physicians, patients, families/caregivers, staff, and community agencies.
  • Review, monitor, evaluate, and coordinate patients' hospital stays to ensure timely and efficient delivery of essential services.
  • Participate in Bed Huddles and carry out recommendations congruent with patients' needs.
  • Coordinate interdisciplinary approaches to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations/approvals as needed.
  • Conduct daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in various settings.
  • Act as a liaison between in-patient facilities and referral facilities/agencies, providing case management to patients referred.
  • Refer patients to community resources to meet post-hospital needs and coordinate transfers to appropriate facilities.
  • Adhere to internal and external regulatory and accreditation requirements and compliance guidelines.
  • Educate healthcare team members about their roles and responsibilities in the discharge planning process and appropriate resource use.
  • Provide patients with education to assist with discharge and help them cope with psychological problems related to acute and chronic illness.
  • Report any incidence of unusual occurrences related to quality, risk, and/or patient safety identified during case review or other activities.
  • Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources and participate in data collection and analysis for special studies, projects, planning, or routine utilization monitoring activities.
  • Coordinate, participate in, or facilitate care planning rounds and patient family conferences as needed.
Requirements
  • Two (2) years combined RN experience in an acute care setting or case management required.
  • Completion of an accredited RN training program that allows graduates to take RN license exam.
  • Registered Nurse License (California) and Basic Life Support certification required.
  • Demonstrated ability to utilize/apply 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
  • Bachelor's degree in nursing or healthcare-related field.
Work Schedule

The position will be 2 two 12-hour shifts and be scheduled Monday to Sunday, with the expectation that they work every other weekend.

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