Case Manager Utilization RN, 40 Hour Day Shift
2 weeks ago
- Plan, develop, assess, and evaluate care provided to members.
- Collaborate with physicians, other members of the multidisciplinary healthcare team, and patient/family in the development, implementation, and documentation of appropriate, individualized plans of care.
- Recommend alternative levels of care and ensure compliance with federal, state, and local requirements.
- Assess high-risk patients in need of post-hospital care planning.
- Develop and coordinate the implementation of a discharge plan to meet patients' identified needs.
- Communicate the plan to physicians, patient, family/caregivers, staff, and appropriate community agencies.
- Review, monitor, evaluate, and coordinate patients' hospital stays to ensure that all appropriate and essential services are delivered timely and efficiently.
- Participate in Bed Huddles and carry out recommendations congruent with patients' needs.
- Coordinate 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.
- Conduct 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.
- Act as a liaison between in-patient facility and referral facilities/agencies and provide case management to patients referred.
- Refer patients to community resources to meet post-hospital needs.
- Coordinate transfer of patients to appropriate facilities; maintain and provide required documentation.
- Adhere to internal and external regulatory and accreditation requirements and compliance guidelines, including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA, and DOL.
- Educate members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
- Provide patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
- Per established protocols, 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 the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.
- Coordinate, participate, and/or facilitate care planning rounds and patient family conferences as needed.
- Participate in committees, teams, or other work projects/duties as assigned.
- 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)
- Basic Life Support
- 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.
- Bachelor's degree in nursing or healthcare-related field.
- Required to work every other weekend.
-
Case Manager Utilization RN, 40/hr Day
3 weeks ago
Anaheim, United States Kaiser Permanente Full timeSign 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...
-
Travel Nurse RN Case Manager
1 month ago
, CA, United States TotalMed Case Management Staffing Full timeJob Title: Travel Nurse RN Case ManagerTotalMed Case Management Staffing is seeking a skilled Travel Nurse RN Case Manager to join our team in Clearlake, California.Job Description:Specialty: Case ManagementDiscipline: Registered NurseDuration: 26 weeksHours: 40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are looking for a dedicated Case...
-
Travel Nurse RN Case Manager
4 weeks ago
Anaheim, California, United States Cross Country Nurses Full timeJob Title: Travel Nurse RN Case ManagementCross Country Nurses is seeking a skilled travel nurse RN Case Management professional to join our team.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNDuration: 28 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelAs a case management nurse (RN CM), you will collaborate with the...
-
Travel Nurse RN Case Manager
1 month ago
Anaheim, California, United States PHP Full timePHP is seeking a skilled travel nurse to join their team as a Case Management RN.Job DetailsSpecialty: Case ManagementDiscipline: RNDuration: 25 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelPHP is committed to providing exceptional employment opportunities for healthcare professionals. With over 20 years of experience, they offer premium...
-
Case Management Utilization RN-Per Diem
4 weeks ago
Anaheim, United States Disability Solutions Full timeJob 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...
-
Travel Nurse RN Case Manager
2 weeks ago
US-, San Francisco, CA, USA TotalMed Case Management Staffing Full timeJob Title: Travel Nurse RN Case ManagerTotalMed Case Management Staffing is seeking a skilled Travel Nurse RN Case Manager to join our team.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelWe are looking for a dedicated Case Manager-Registered Nurse to work with us in San Francisco, California.TotalMed Case...
-
RN Case Manager
3 weeks ago
Anaheim, United States Scout Exchange Full timeTitle - RN Case Manager Location - Anaheim, CA 92805 Shift - Day 5x8-Hour (08:00 - 17:00) Contract - 13 weeks Description: Must have 2 years of Case Management Experience. Start date: ASAP Years of experience Required: 2 First-timers accepted: Yes Call not required Locals accepted? Yes RTO Restrictions: Please include all RTO at the time of submittal....
-
Case Manager Utilization RN, PD Day
2 weeks ago
downey, CA, United States Kaiser Permanente Full timeJob 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, PD Day
2 weeks ago
downey, CA, United States Kaiser Permanente Full timeJob 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, PD Day
2 weeks ago
downey, CA, United States Kaiser Permanente Full timeJob 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...
-
Clinical Case Manager
2 weeks ago
Anaheim, California, United States Scout Exchange Full timeJob Summary:Scout Exchange is seeking a skilled RN Case Manager to join our team. The ideal candidate will have 2 years of experience in case management and a strong understanding of managed care and payment systems.Key Responsibilities:Provide case management services to patients with acute care needs.Develop and implement care plans to ensure optimal...
-
Case Manager Utilization RN, 32/hr Day
6 days ago
Los Angeles, CA, United States Kaiser Permanente Full timeSign 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, 32/hr Day
6 days ago
Los Angeles, CA, United States Kaiser Permanente Full timeSign 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, Per Diem Day
2 weeks ago
downey, CA, United States Kaiser Permanente Full timeJob 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...
-
Local Contract Nurse RN Case Manager
1 month ago
Fontana, CA, United States Pyramid Consulting Full timePyramid Consulting is seeking a skilled contract nurse RN to fill a Case Management position in Fontana, California.Job DetailsSpecialty: Case ManagementDiscipline: RNDuration: 12 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Local ContractThis is a 13-week contract opportunity with the possibility of extension or conversion to a permanent...
-
Travel Nurse Case Manager
2 weeks ago
US-, San Francisco, CA, USA TotalMed Case Management Staffing Full timeJob Title: Travel Nurse Case ManagerTotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a challenging opportunity.Job RequirementsSpecialty: Case ManagementDiscipline: RNShift: 8 hours, daysEmployment Type: TravelWe are seeking a skilled Case Manager-Registered Nurse for an assignment with TotalMed Case Management Staffing.The...
-
Case Manager Utilization RN, Per Diem Day
3 weeks ago
downey, CA, United States Kaiser Permanente Full timeJob 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, Per Diem Day
2 weeks ago
downey, CA, United States Kaiser Permanente Full timeJob 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, 32/hr Day
1 month ago
Los Angeles, CA, United States Kaiser Permanente Full timeSign 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...
-
Travel Nurse RN Case Management Opportunity
2 months ago
Kentfield, CA , USA, United States QS Nurses Full timeQS Nurses is seeking a skilled travel nurse RN to fill a Case Management position. Job Details Specialty: Case Management Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel QS Nurses offers a competitive pay package based on 8 hour shifts and 40 hours per week, with a tax-free stipend amount to be determined....
