Case Manager (Acute Care) - RN, Case Manager II

Quick Facts

• Role: Case Manager (Acute Care) – RN (Case Manager II)

• Focus: Care coordination and care transitions planning

Description

Provide care coordination and care transition planning throughout the acute care patient experience to support timely progression and appropriate transitions to the next level of care, preventing unnecessary admissions or readmissions. Collaborate with physicians, utilization managers, medical social workers, bedside RNs, interdisciplinary teams, payers, and community resources to coordinate care across the continuum. If assigned to the Emergency Department, manage complex clinical and social situations efficiently to avoid unnecessary admissions.

Responsibilities

• Coordinate the care management process to facilitate communication across the continuum

• Ensure timely progression and transition of patients to the appropriate level of care

• Partner with interdisciplinary teams and internal/external stakeholders, including patients and families

• Coordinate resources and support appropriate utilization balanced with patient self-determination

• Collaborate with physicians, nursing management, quality, ancillary services, third-party payers, review agencies, claims and finance departments, medical directors, and contracted providers

• Support emergency department care management for complex clinical/social situations

Requirements

• Graduate of an accredited school of nursing

• RN-Registered Nurse of California required

• Two years recent relevant experience OR a Master’s degree in Nursing with specialization in Case Management

• Broad knowledge of healthcare delivery and case management in a managed care environment

• Comprehensive knowledge of utilization review, levels of care, and observation status

• Knowledge of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, alternative payment systems

• Knowledge of laws, regulations, and professional standards affecting case management (including CMS, Title 22, CHA Consent Manual, CDPH, TJC)

• Knowledge of post-acute levels of care and related regulatory compliance requirements

• General understanding of coding and DRG assignment preferred

• Strong verbal and written communication and negotiation skills

• Ability to communicate and promote cooperation across patients/families/caretakers, physicians, nurses, and ancillary partners

• Ability to work independently and exercise sound judgment with physicians, payers, and patients/families

• Commitment to service excellence and quality patient care with a positive patient experience

• Excellent time management skills for organized work processes in a high-volume, rapidly changing environment

• Intermediate computer and technology skills

Benefits

• Comprehensive benefits package (details available through the employer)

• Total rewards program includes base pay plus eligible benefits

Pay

• $90.58 to $126.81 per hour (based on primary work location)

• Starting salaries consider experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs