RN Case Manager III
2 weeks ago
TitleRN Case Manager III
LocationLong Beach
Department Care Coordination
StatusFull time
ShiftDay
Pay Range $56.68/hr - $80.18/hr
Sign on$10,000
At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare.Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability.Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.
Position Summary
The case manager III, CaseManager isa licensed professional who plans, coordinates and facilitates the ongoing care and appropriate discharge plan of a specific caseload of patients through the continuum of care.The case manager III collaborates with members of the health care team, the patient, and their family to assure effective, efficient, and appropriate care and outcomes. The incumbent is accountable for education, monitoring, utilization and evaluation of medical outcomes.
Essential Job Outcomes & Functions Care Management
Case Management
The case manager III independently manages a specific case load of patients as identified by the Resource Management Department and CareLines. Thecase manager analyzes patient information and assess each patient’s functional status and decision making ability in relation to the continuum of care and discharge needs. The case manager collaborates with the health care team, patient, and family in planning and facilitating the achievement of expected outcomes for patients. Each treatment plan is evaluated for appropriate quality outcomes and utilization of resources.
Continuum of Care/Quality
The case manager III works collaboratively with the health care team to provide education, resources, and referrals as needed for each patient and their family or caretaker. The case manager facilitates coordination among health care professionals, services, and settings involved in the patient’s care, with a focus on enhancing patient satisfaction. The case manager actively communicates with nursing leadership, CareLine physician directors, and Medical Directors on quality issues. As appropriate, concerns are referred to various Medical Staff Committees and CareLines through required documentation, including but not limited to the Clinical Pertinence Review Form. The case manager has the responsibility to maintain professionalism and provide ongoing education to the health care team regarding the case manager’s role.
Utilization Management
The case manager works collaboratively and proactively with payors in managing patient resources. The case manager assures the hospital receives appropriate reimbursement through collaboration with the health care team and provides timely clinical review, as well as retroactive review for unbilled accounts. The case manager utilizes the billing system to analyze charges vs. reimbursement and contract information. This information is used to structure the health care team toward effective utilization of resources. The case manager incorporates knowledge of medical necessity, CareLine protocols, and MAPs to evaluate for appropriateness of admissions, continued stay, and discharges. The case manager refers cases, as appropriate, for review to the
Combined Resource Management Committee and other Medical Staff Committees as needed.
Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities.Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.
Qualifications
Experience
- This position requires strong verbal and written communication skills with the ability to communicate well with people from diverse socioeconomic backgrounds.
- The case manager is knowledgeable of criteria for medical necessity for each level of care through the continuum of care. A knowledge of reimbursement related to MediCare, MediCal, Capitation, and Managed Care is required.
- Three to five years acute care or home health experience plus prior experience in Quality Improvement, Case Management, Discharge Planning or Utilization Management required.
- Current California RN License.
- BSN or Bachelors degree in health or related field preferred
-
Long Beach, United States Lutheran Social Services of Southern California Full timeDescription: - Lutheran Social Services of Southern California began in December 1944 when a group of Lutheran congregations in San Diego came together to discuss how to better assist families in need. They began discussing how to form a Welfare Commission. Their vision expanded when they came together with another group of Lutheran congregations in Los...
-
Telephonic Case Manager
2 days ago
Long Beach, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONWe are seeking a (RN) Registered Nurse who lives in Nebraska and is licensed there. Case Manager will work in remote setting supporting our Medicaid Population providing telephonic support to our members, completing assessments and creating care plans., You will participate in interdisciplinary care team meetings for our members...
-
Case Manager
2 weeks ago
Long Beach, United States PROJECT 180 INC Full timeThe Organization SSG-Project 180 turns lives around through innovative, wraparound services that keep people out of institutions and in their communities. Project 180 is a leader in the forensic treatment space, offering high-quality, specialized treatment programs that serve thousands of justice-involved individuals. Our programs span criminal justice...
-
Case Manager
4 days ago
Long Beach, United States PROJECT 180 INC Full timeThe Organization SSG-Project 180 turns lives around through innovative, wraparound services that keep people out of institutions and in their communities. Project 180 is a leader in the forensic treatment space, offering high-quality, specialized treatment programs that serve thousands of justice-involved individuals. Our programs span criminal justice...
-
Telephonic Case Manager
1 week ago
Long Beach, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONWe are seeking a (RN) Registered Nurse who lives in Nebraska and/or Iowa and must be licensed for the state they reside. Case Manager will work in remote setting supporting our Medicaid Population providing telephonic support to our members, completing assessments and creating care plans., You will participate in...
-
Telephonic Case Manager
4 days ago
Long Beach, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONWe are seeking a (RN) Registered Nurse who lives in Nebraska and/or Iowa and must be licensed for the state they reside. Case Manager will work in remote setting supporting our Medicaid Population providing telephonic support to our members, completing assessments and creating care plans., You will participate in...
-
Case Manager
4 weeks ago
Long Beach, United States Molina Healthcare Full timeJob Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired...
-
Field Case Manager, LTSS
2 days ago
Long Beach, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONJob Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients...
-
Case Manager
4 weeks ago
Long Beach, United States Project 180 Full timeJob DescriptionJob DescriptionThe OrganizationSSG-Project 180 turns lives around through innovative, wraparound services that keep people out of institutions and in their communities. Project 180 is a leader in the forensic treatment space, offering high-quality, specialized treatment programs that serve thousands of justice-involved individuals. Our...
-
Case Manager
2 weeks ago
Long Beach, United States PROJECT 180 INC Full timeThe Organization SSG-Project 180 turns lives around through innovative, wraparound services that keep people out of institutions and in their communities. Project 180 is a leader in the forensic treatment space, offering high-quality, specialized treatment programs that serve thousands of justice-involved individuals. Our programs span criminal justice...
-
Registered Nurse
2 weeks ago
Long Beach, United States Oxford HealthCare Full timeAt Oxford Health Care, relationships and clinical excellence go hand in hand. That’s what makes our one-on-one home health services so special for clients and so rewarding for clinicians. We take the time to consider those who would be a great fit for you personally, because making that right connection is key to improving outcomes and providing the best...
-
Long Beach, United States Molina Healthcare Full timeJob Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired...
-
RN III Surgery
2 weeks ago
Long Beach, United States Common Spirit Full timeOverview CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our...
-
RN III Surgery
2 weeks ago
Long Beach, United States Dignity Health Full time**Overview** CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before....
-
RN III Surgery
6 days ago
Long Beach, United States Dignity Health Full time**Overview** CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before....
-
Case Manager | Enhanced Case Management
16 hours ago
Long Beach, United States April Parker Foundation Full timePosition Summary The Case Manager | Enhanced Case Management (ECM) will provide comprehensive case management services to individuals and families, focusing on enhancing their access to necessary resources and support. As a Case Manager, you will work closely with clients to conduct assessments, develop care plans, and provide ongoing support and advocacy....
-
Case Manager Ii
4 weeks ago
Long Beach, United States TEEMA Group Full time**Case Manager** case management services to clients, including assessment, planning, coordination, monitoring, and evaluation of services. **Responsibilities**: - Provide case management services to clients, including assessment, planning, coordination, monitoring, and evaluation of services. - Develop and implement individualized service plans for...
-
Case Manager I
3 weeks ago
Long Beach, United States Tarzana Treatment Center Full timeJob DescriptionJob DescriptionPosition Title: Case Manager IDepartment: Community Supports- Housing Transition and NavigationReports To: As assigned by Program Senior Supervisor/DirectorPOSITION SUMMARYProvides case management services to members assigned to individual caseload. As a Housing Case Manager, Case Managers are expected provide high quality case...
-
Case Management
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...
-
Case Management
2 weeks ago
Long Beach, United States Blue Shield of California Full timeYour Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...