RN Case Manager

4 weeks ago

Huntington Park, California, United States Community Hospital of Huntington Park Full time
Job Summary

Community Hospital of Huntington Park seeks a skilled RN Case Manager to perform utilization review, discharge planning, and care coordination to ensure efficient patient progression and payment for services provided.

Key Responsibilities
  • Serves as a liaison between the hospital and payers to ensure financial coverage for patients.
  • Coordinates resources and services for patients and families in response to individual needs and fiscal responsibilities.
  • Works with the multidisciplinary team to ensure coordination of patient care and wise utilization of resources.
  • Documents case management activities in the patient record and required information system.
  • Reports to the Director/Manager of the department.
Essential Job Duties
  • Applies clinical knowledge to identify patient needs and communicate medical necessity and treatment plan to payers.
  • Reviews inpatients for appropriateness of admission, level of care, and length of stay using InterQual criteria.
  • Collaborates with the multidisciplinary team to develop, coordinate, implement, and evaluate patient care.
  • Identifies and anticipates discharge needs and collaborates with the team to ensure timely discharge planning.
  • Educates and collaborates with the team regarding utilization issues, documentation of medical necessity, discharge options, and community resources.
  • Anticipates barriers to efficient patient progression by identifying clinical, operational, financial, and social issues affecting patient outcomes.
  • Estimates expected length of stay and communicates with the team to ensure efficient patient progression.
  • Identifies patients at risk for extended lengths of stay, readmission, and complex discharge needs.
  • Identifies and documents avoidable days to address opportunities for improvement.
  • Prevents denials and disputes by communicating with payers and documenting relevant information.
  • Promotes prudent utilization of resources by evaluating resources available to patients and balancing cost and quality to ensure optimal clinical and financial outcomes.
Licensure/Certifications
  • Current RN license in good standing by the California Board of Nursing.
  • Current BLS for Health Care Provider card.
  • Accredited Case Manager (ACM) or Certified Case Manager.

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