Registered Nurse Case Manager (Care Management)

Quick Facts

• Role: Registered Nurse Case Manager (Care Management)
• Focus: Care coordination and care transitions throughout acute care

Description

Provide RN-led care coordination and planning to help patients progress and transition to the appropriate level of care in a timely manner, preventing unnecessary admissions or readmissions. Collaborate with physicians, utilization management, medical social workers, bedside RNs, interdisciplinary teams, and payers/review agencies to coordinate care across the continuum. If assigned to the Emergency Department, address complex clinical and social situations efficiently to avoid unnecessary admissions.

Responsibilities

• Coordinate care and care transitions across the acute care patient experience
• Ensure timely progression to the appropriate level of care
• Communicate and facilitate care across the continuum through effective resource coordination
• Collaborate with patients, families, physicians, interdisciplinary teams, nursing management, quality, ancillary services, third-party payers, review agencies, and contracted/community resources
• Promote quality patient care and a positive patient experience

Requirements

• Graduate of an accredited school of nursing
• RN-Registered Nurse of California upon hire
• 2 years recent relevant experience OR graduate of an accredited Master’s degree program in Nursing with a specialization in Case Management
• Experience in acute care case management or health plan case management/utilization management
• Knowledge of utilization review, levels of care, and observation status
• Knowledge of healthcare reimbursement systems and value-based reimbursement models
• Working knowledge of laws, regulations, and professional standards affecting case management practice (including CMS, Title 22, CHA Consent Manual, CDPH, TJC)
• Knowledge of post-acute levels of care and regulatory compliance requirements
• General understanding of coding and DRG assignment process preferred
• Strong communication, negotiation, and collaboration skills
• Ability to work independently, manage high-volume priorities, and exercise sound judgment
• Intermediate computer and technology skills

Benefits

No benefits listed in the posting.