Case Manager

1 week ago

Loma Linda, California, United States Loma Linda University Full time
Job Summary

The Case Manager serves as a key member of the patient care delivery team in a Magnet Recognized large tertiary academic medical center with level one trauma designation, ST-Elevation Myocardial Infarction (STEMI) receiving center designation, and Comprehensive Stroke Center and Chest Pain Center accreditation. This role requires efficient work in a fast-paced environment, utilizing clinical expertise, discretion, and independent judgment in performing the nursing process (assessment, care planning, intervention, evaluation) within a patient-centered care professional practice model (Duffy's Quality-Caring Model) and as it relates to case management functions.

Responsibilities
  • Maintains a solid working knowledge of specialized case and utilization management methodologies and practices, applying concepts to everyday practice.
  • Ensures medical appropriateness criteria (medical necessity) are met for the level of care provided and documented from admission through discharge.
  • Practices in a collaborative healthcare environment to oversee implementation of a well-thought-out interdisciplinary plan of care with an individualized discharge plan that is comprehensive and best meets the continuing healthcare needs of the patient.
  • Reevaluates the plan of care and ensures continued appropriateness based on the patient's changing needs and condition.
  • Functions within the expectations of a professional nurse and meets nursing excellence standards to achieve and maintain Magnet Recognition as outlined by the American Nurses Credentialing Center.
Requirements
  • Bachelor's Degree in nursing required.
  • Minimum of one year of patient care experience required.
  • Minimum of two years of Hospital Case Management or Utilization Management experience preferred.
Preferred Qualifications
  • Nationally recognized certification in Utilization Management or Case Management.

Loma Linda University is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive environment that values diversity and promotes equal opportunities for all employees and applicants.

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