Case Manager RN

2 weeks ago


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

The RN-Case Manager plays a vital role in ensuring the delivery of high-quality, patient-centered care. This position is responsible for utilization management and inpatient care management, utilizing a telephonic and/or onsite approach. The RN-Case Manager will perform reviews of inpatient and outpatient services to determine medical appropriateness, adhering to established medical guidelines and benefit determinations.

Through collaborative efforts with multidisciplinary teams, the RN-Case Manager will individualize care to enhance achievement of mutually set goals, ensuring effective and efficient use of resources within fiscal realities.

The RN-Case Manager will serve as a liaison between the patient and the primary care physician, promoting seamless, quality care that enhances quality of life.

This role requires participation in on-call rotations after-hours and/or on weekends as needed to meet contractual obligations and provide decision support for managed care issues.

The RN-Case Manager will perform other duties as needed.


Requirements:
  • High School Diploma or GED required
  • Bachelor's Degree in Nursing preferred
  • Minimum three years of experience as a Registered Nurse required
  • Minimum two years of case management experience required

Key Skills:
  • Knowledge of patient care management principles and practices
  • Evaluation and assessment methodologies to identify functional, social, psychological, environmental, learning, and financial needs of patients
  • Effective communication and interpersonal skills
  • Ability to work calmly and respond courteously under pressure
  • Leadership and supervisory skills

Licensures and Certifications:
  • Active California Registered Nurse (RN) required
  • Basic Life Support (BLS) certification from the American Heart Association (AHA) required
  • Commission of Case Manager (CCM) certification preferred

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