Care Coordinator / Case Manager

Pacifica Hospital of the Valley; Los Angeles (CA); On-site; USD 90,000 - 110,000; Full time

Job summary

Pacifica Hospital of the Valley in Los Angeles seeks a Care Coordinator to work with physicians, nursing staff, and families to design and monitor individualized care plans, ensuring safe, cost-effective, high-quality outcomes.

You will perform utilization review, coordinate post-acute care, and support discharge planning with payer criteria, focusing on clear communication, organization, and analytical thinking.

Qualifications

• Active CA Registered Nurse license
• Bachelor’s degree in Nursing or Healthcare field (RN preferred)
• Prior experience as a Care Coordinator / Case Manager
• Ability to effectively communicate to payer medical necessity/appropriateness/level of care criteria
• Working knowledge of Hospital revenue cycle / reimbursement
• Excellent organizational skills
• Excellent critical thinking and analytical skills

Responsibilities

• Assesses, coordinates, develops and implements individualized care plans utilizing evidence-based tools to ensure delivery of safe high quality, efficient and cost-effective care.
• Performs utilization review functions to guide billing and level of care practices.
• Assures delivery of concurrent and post-hospitalization care through initiation of referrals, coordination of resources utilization and evaluation of post-acute care services.
• Provide advice and counsel to TAR/Authorization and Discharge planning staff.
• Review one-day admits for appropriateness (inpatient verses oberservation)

Skills

Communication

Organizational skills

Critical thinking

Education

CA RN license

Bachelor’s degree in Nursing or Healthcare

Job description

The CARE COORDINATOR, will work in collaboration with the multidisciplinary team, including, but not limited to, Physicians, Nursing, Ancillary,and Professional staff, along with patients and families to ensure appropriate care coordination services by evaluating options and services required to meet an individual’s healthcare to promote safe, cost-effective, quality outcomes.

RESPONSIBILITIES:

• Assesses, coordinates, develops and implements individualized care plans utilizing evidence-based tools to ensure delivery of safe high quality, efficient and cost-effective care.
• Performs utilization review functions to guide billing and level of care practices.
• Assures delivery of concurrent and post-hospitalization care through initiation of referrals, coordination of resources utilization and evaluation of post-acute care services.
• Provide advice and counsel to TAR/Authorization and Discharge planning staff.
• Review one-day admits for appropriateness (inpatient verses oberservation)

EDUCATION/TRAINING/EXPERIENCE:

• Active CA Registered Nurse license
• Bachelor’s degree in Nursing or Healthcare field (RN preferred)
• Prior experience as a Care Coordinator / Case Manager
• Ability to effectively communicate to payer medical necessity/appropriateness/level of care criteria
• Working knowledge of Hospital revenue cycle / reimbursement
• Excellent organizational skills
• Excellent critical thinking and analytical skills