Case Manager – Care Coordinator – Days

The purpose

The purpose of the Case Manager position is to support the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions.

Specific functions

• Facilitation of pre-certification and payer authorization processes
• Facilitation of the collaborative management of patient care across the continuum
• Intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement
• Application of process improvement methodologies in evaluating outcomes of care support and coaching of clinical documentation efforts
• Serving as a clinical resource for coders
• Coordinating communication with physicians

Qualifications

• Minimum Education: Associate’s Degree Nursing
• Minimum Skills:
• Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
• Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
• Excellent interpersonal communication and negotiation skills.
• Strong organizational and time management skills, as evidenced by a capacity to prioritize multiple tasks and role components.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources.
• Strong analytical, data management, and PC skills.
• Required Certifications:
• Registered Nurse - RN (CA Board of Registered Nursing)
• Basic Life Support (BLS) Healthcare Provider from American Heart Association
• PREFERRED EXPERIENCE: 3 years Clinical experience in Utilization Review and Discharge Planning in an Acute Hospital strongly preferred.

About the Hospital

At Keck Medicine of USC, diversity means recognizing the richness of our differences and celebrating them together. Our nurses enjoy a wide array of competitive benefits, including free tuition at USC for both employees and their families. We provide exceptional healthcare, retirement benefits and quality of life programs designed to help you make the most of your experience at Keck Medicine of USC; and discounts on a wide variety of services, including public transportation passes, campus fitness center memberships and event tickets.