Case Manager RN

5 days ago

Los Angeles, United States Pyramid Consulting, Inc Full time

Immediate need for a talented Case Manager RN. This is a 01+months contract opportunity with long-term potential and is located in Los Angeles CA (Onsite). Please review the job description below and contact me ASAP if you are interested.


Job ID: 24-48347


Pay Range: $75 - $79/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).


Key Responsibilities:


  • Plans, develops, assesses and evaluates care provided to members, collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, Implementation and documentation of appropriate, individualized plans of care to ensure continuity. quality and appropriate resource use.
  • Recommends alternative levels of care and ensures compliance with federal, state and local requirements. Assesses high risk patients in need of post-hospital care planning.
  • Develops and coordinates the implementation of a discharge plan to meet patient's identified needs. Communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies.
  • Reviews, monitors, evaluates and coordinates the patient's hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
  • Participates in the Bed Huddles and carries cut recommendations congruent with the patient's needs. Coordinates the Interdisciplinary approach to providing continuity of care, including Utilization Management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families.
  • Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, Inpatient and non-KFH facilities. Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
  • Refers patients to community resources to meet post-hospital needs,
  • Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation. Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, Client, HCFA, CMS, DMHG, NCQA and DOL
  • Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources,
  • Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic Illness. Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities,
  • Reviews, analyses and identifies utilization patterns and trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.
  • Coordinates, participates and or facilitators care planning rounds and patient family conferences as needed. Participates in committees, teams or other work projects/duties as assigned.


Key Requirements and Technology Experience:


  • Key Skills:Case management experience within Appeals ,Grievance, Utilization , conducting investigations .
  • Bachelor's degree in nursing or healthcare related field.
  • Completion of an accredited RN training program that allows graduates to take RN license exam.
  • Two (2) years clinical experience as an RN in an acute care setting required.
  • Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management.
  • Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).


Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.


Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.


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