RN Case Manager

About the role

The Center for Elders’ Independence (CEI) is a PACE (Program of All-Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and implementation to provide high‑quality, affordable, integrated health‑care services to the elderly, promote autonomy and quality of life, and enable individuals to live in their communities. The Coordination of Care Service Center RN Case Manager monitors and facilitates appropriate resource management for CEI participants in hospital and skilled nursing facility (SNF) settings, collaborates with internal and external providers to ensure optimal participant disposition, and serves as the single point of contact for hospitals during business hours.

Responsibilities

• Assess and evaluate care provided to CEI members in non‑CEI settings.
• Develop and evaluate appropriate treatment plans in conjunction with providers.
• Assure appropriate, timely review and authorization for hospital or SNF stays.
• Act as CEI’s single point of contact and liaison for hospitals during business hours.
• Review clinical information and collaborate with internal and external physicians and other providers for optimal and timely disposition.
• Communicate frequently with CEI physicians and the interdisciplinary team (IDT) to assure and execute optimal discharge and continuity of care plans.
• Develop collaborative, productive relationships with hospital and SNF health‑care providers to achieve optimal participant care and outcomes across the continuum.
• Be knowledgeable regarding contracts and CEI benefit coverage; identify appropriate level of care for SNF placement and provide guidance to the IDT.
• Collaborate with CEI physicians to oversee care of CEI participants at SNFs.
• Monitor and document participants’ care according to established skilled‑care guidelines.
• Assist with development, review, and revision of departmental policies and procedures that support positive outcomes and organizational objectives.
• Investigate participant concerns as identified and offer satisfactory resolution regarding the case‑management role.
• Consistently comply with the organizational Code of Conduct by maintaining privacy and confidentiality, protecting assets, acting with ethics and integrity, reporting non‑compliance, and adhering to applicable federal, state, and local laws, regulations, accreditation, and license requirements.
• Model ethical behavior, adhere to organizational policies and guidelines, maintain confidences, admit mistakes, conduct work honestly, show consistency in words and actions, and follow through on commitments.
• Demonstrate openness to creative and innovative approaches to providing service.
• Check for new hospital admissions and ED visits via Direct Line Tele‑Response fax transmission; record ED notifications and e‑mail messages to the Clinic IDT.
• Locate contracted SNFs, obtain physician approval/authorization for participants requiring short‑term placement.
• Request hospital documentation for hospital stays and ED visits; ensure provider review.
• Ensure status updates are transmitted via e‑mail to all relevant parties as they occur for any participant going to or being discharged from the ED, hospital, and/or SNF.
• Perform other related duties as required or assigned to support the efficient operation of the department and organization.

Qualifications

• BSN in Nursing required from an accredited school of nursing.
• CCM preferred.
• Current California Nursing RN license required.
• CPR certificate required.
• 3‑5 years of Case Management experience required; PACE work experience preferred.
• Understanding of the Nurse Practice Act and all other local, state, and federal regulations.
• Demonstrated strong interpersonal communication skills.
• Experience working with electronic medical records and intermediate/advanced computer skills (Microsoft Office Suite) required.
• Ability to perform duties in a heavy workload, fluctuating environment.

Pay

The annual pay range for the CCSC RN Case Manager position at Center for Elders’ Independence is $104,332 to $159,629. Placement within the range is determined based on job‑related factors such as relevant experience, skills, abilities, internal equity, and market data, consistent with CEI’s annual compensation review and established compensation practices.