Case Manager Specialist RN - Cardiology

About the role

Works collaboratively with an assigned panel of physicians to manage the patients' specialized needs. The managing team differs according to the chronic disease. Duties include assessment to identify member needs and development of a specific care management plan to address those needs. In conjunction with the physician, implements the care/treatment plan by coordinating access to health services across multiple providers/disciplines, monitors care, arranges transportation and transfer of patients when indicated, identifies cost‑effective measures, recommends alternative levels of care and utilization of resources, promotes self‑care management, and ensures paperwork is completed. Acts as an indirect caregiver and complies with other duties as described. Must be able to work collaboratively with the multidisciplinary team.

Responsibilities

• Evaluates and identifies members’ needs.
• Interfaces with primary care physicians, specialists, and various disciplines to develop case management plans/programs.
• Monitors and evaluates the effectiveness of case management plans and modifies them as necessary.
• Coordinates an interdisciplinary approach to continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers for outside services.
• Acts as a clinical liaison with outside agencies such as County CCS, non‑plan facilities, employers, workers’ compensation carriers, and third‑party administrators.
• Prepares reports, communicates program changes to staff, and develops protocols in accordance with state regulations.
• Advocates for and educates patients to ensure they understand and are empowered to participate in their plan of care.
• Develops individualized patient/family education plans focused on self‑management and delivers disease‑specific education.
• Creates and updates training and educational materials and presents them to staff, members, and families.
• Facilitates patients’ return to normal daily activities by teaching and making appropriate referrals for outside services or continued care.
• Consults with internal and external physicians, health‑care providers, discharge planners, and outside agencies regarding continued care, hospitalization, or referral to support services or placement.
• May arrange transportation and housing for patients as needed.
• Coordinates transmission of clinical and benefit information to patients, families, and outside agencies.
• Participates in data collection and analysis of clinical outcomes and customer satisfaction standards.
• Participates in formulation, implementation, and monitoring of action strategies and outcomes of care or customer service.
• Ensures accurate records are maintained for each patient’s care.
• Interprets regulations, health‑plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.

Basic Qualifications

• Minimum two (2) years clinical experience as an RN in an acute care or ambulatory care setting.
• Home Based Cardiac Rehab Program: one (1) year clinical experience in Cardiology.
• High Risk Infant Program: Bachelor’s degree in nursing or related field.

Education

Bachelor’s degree or equivalent experience (four years required). Specific programs may require a degree in nursing or a related field.

Licensure & Certifications

• Registered Nurse License (California).
• Basic Life Support (BLS) – required unless noted otherwise for specific programs.
• Cancer Program: Oncology Certified Nurse (OCN) required within one (1) year of hire.
• High Risk Infant Program: Must meet requirements to be a CCS paneled provider.
• Regional Genetic Screening Program: BLS not required.

Additional Requirements

• Demonstrated ability to apply utilization review/management, care coordination, transfer coordination, discharge planning, or case management principles.
• Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi‑Cal, etc.).
• Strong written and verbal communication, interpersonal, critical‑thinking, and problem‑solving skills.
• Computer literacy.

Preferred Qualifications

• Case Management Certification or certification in the area of specialty.
• Bachelor’s degree in nursing or a healthcare‑related field.

Schedule

Full‑time, scheduled shift Monday‑Friday 8:00 AM – 4:30 PM. May rotate weekends and holidays.

Pay

Pay range: $64.74 – $79.23 per hour. The posted range reflects possible base salaries and does not include the full value of the total rewards package.

Location

Primary location: Los Angeles, California – 1526 N. Edgemont Medical Offices.

Work Setting

Onsite, employee status: Regular employee, union affiliation B21|AFSCME|SCNSC, individual contributor level, Department: 1526 Edgemont MOB – Cardiology‑Reg Clinic – 0806.