Patient Care Management RN

2 weeks ago

Beverly Hills, California, United States National Guard Employment Network Full time

Job Overview


ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization collaborates with partner companies to identify qualified candidates for their available positions.

This opportunity is open to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers.

If you possess the necessary qualifications, educational background, and experience, please proceed with the application process.

Unless otherwise specified, this role is designated as "On-Site" at the location indicated in the job listing.


The RN Care Coordinator plays a crucial role in managing patient care during hospitalization and following discharge from various healthcare environments.

Working in conjunction with the Inpatient Specialty Program (ISP) hospitalists, the RN Care Coordinator supports patients from admission through discharge by evaluating their needs, coordinating care, and liaising with health plans. This includes concurrent reviews to assess the appropriateness of services provided and to ensure that quality care is delivered efficiently.


Key Responsibilities:
Conducts initial assessments with patients within 24 hours of admission.

Engages with the assigned hospitalist daily during morning rounds to discuss disposition planning and care appropriateness for each day of the patient's stay.

Evaluates the patient's admission and ongoing stay for medical necessity, care appropriateness, and level of care using Milliman and Interqual guidelines as necessary.
Plans for discharges and care assessments.

Submits essential clinical information to the health plan in the required format and coordinates communication with the assigned hospitalist as needed.

Collaborates with Nurse Practitioners and ISP Hospitalists assigned to Skilled Nursing Facilities (SNFs) for ongoing review and follow-up.
Communicates the transition of care to the member or responsible party, including: i) Transition process and expectations ii) Changes in health status and care plan iii) Staff responsible for addressing issues, questions, and concerns, such as the Care Coordinator.
Authorizes all relevant services based on covered benefits and necessity of care provided in: a) Member's home or residence b) Acute Care c) Skilled Nursing Facility d) Rehabilitation Facility e) Home Health Care f) Custodial Care facility or Board and Care Facility.
Facilitates discharge planning and alternative treatment strategies with the Primary Care Provider (PCP), hospitalist, and specialists as appropriate.
Arranges outpatient follow-up appointments and schedules tests or outpatient procedures with suitable healthcare providers.

Refers patients identified as needing oversight of outpatient care and compliance to Ambulatory Case Managers to prevent unnecessary readmissions.

Coordinates referrals and secures appointments with various Cedars-Sinai Medical Network disease management programs.

Qualifications and Certifications

Education:
Associate's degree or college diploma in Nursing is required. A Bachelor's degree from an accredited nursing program is preferred.

License/Certification:
Current California RN state license is required. Certification in Case Management as an RN is preferred.

Work Experience:
A minimum of three (3) years of acute nursing experience (RN and/or LVN) is required. At least one (1) year of prior experience in case management within acute inpatient or outpatient settings is necessary.

Minimum Salary
48.21
Maximum Salary
77.14

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