Case Manager, RN

About the role

The RN Case Manager coordinates care, performs utilization reviews, acts as a resource to patients, families, and nursing units; refers patients to clinical social workers for psycho-social issues and complex discharge planning; oversees post-hospital care needs; interacts with insurance companies, medical groups, and community resources to ensure timely and efficient use of all services.

Responsibilities

• Anticipate and address patient needs based on expected clinical processes, available resources, medical necessity criteria, regulatory requirements, and relevant standards of care.
• Manage patient throughput across the continuum of care using an interdisciplinary approach to achieve optimal outcomes.
• Work collaboratively with a multidisciplinary team to facilitate patient care throughout an acute episode of care.

Requirements

• Current CA RN license
• Current BLS provider card
• Case Management certification preferred
• Two (2) years as a Case Manager in an acute care setting or five years recent acute care nursing experience preferred

Qualifications

• Diploma, AA, BS in Nursing
• MS in Nursing preferred

Skills

• Develops, maintains, and models professional, objective, and value-oriented interpersonal skills
• Maintains positive and proactive communication with patients, families, staff members, and physicians
• Fosters team-building relationships
• Excellent organizational skills and the ability to problem solve
• Strong interpersonal skills, leadership ability, negotiation skills, and knowledge of hospital operations
• General knowledge of the payer industry, resource management, reimbursement, and evidence-based clinical practice
• Knowledge of InterQual and/or Milliman preferred

Benefits

Henry Mayo Newhall Hospital offers a comprehensive benefits package including:

• Patient-centered philosophy
• Positive and proactive communication
• Team-building relationships
• Professional development opportunities
• Competitive compensation and benefits
• Flexible work arrangements

Pay

$51.31 to $78.76 per hour

Schedule

Full-time position