Clinical Case Manager

3 weeks ago


Loma Linda, California, United States Loma Linda University Medical Center Full time

Job Summary:

The Clinical Case Manager at Loma Linda University Medical Center utilizes clinical expertise and independent judgment to apply specialized case and utilization management methodologies and practices to ensure medical appropriateness criteria is met and level of care provided is documented. This role serves as a resource to the Collaborative Practice Care Management Team (CPCM) to coordinate care, patient flow, and medically appropriate cost-effective quality healthcare.

Key Responsibilities:

  • Identify high-risk financial, clinical, and social cases with potential negative impact and offer CPCM Team solutions and alternatives for care.
  • Negotiate reimbursement with payer sources for unique and complex cases.
  • Utilize knowledge in the delivery of quality whole person care.
  • Utilize interpersonal skills that support excellence in customer service, safe patient care, and professionalism.

Requirements:

  • Bachelor of Science degree in nursing required.
  • Minimum two years of hospital nursing experience required.
  • Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred.

Preferred Qualifications:

  • Working knowledge of regulatory requirements and accreditation standards preferred.
  • Able to read, write, and speak with professional quality.
  • Able to relate and communicate positively, effectively, and professionally with others.

Licensures and Certifications:

  • Active California Registered Nurse (RN) license required.
  • Basic Life Support (BLS) certification issued by the American Heart Association required.
  • Nationally recognized certification in Utilization Management, Case Management, or Quality preferred.

Our Mission:

Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, excellence, humility, integrity, justice, teamwork, and wholeness.


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