Case Manager*

Loma Linda University Health; Murrieta (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Loma Linda University Health in Murrieta, CA is seeking a Case Manager who will serve as a key member of the patient care delivery team. The position emphasizes management of assessment, care planning, intervention and evaluation within a patient-centered care model, with emphasis on discharge planning and collaboration.

The role requires a BSN, at least two years of hospital nursing experience, and experience in case management or utilization review.

Qualifications

• BSN required.
• Minimum two years of hospital nursing experience.
• Minimum two years of case management, utilization review, or discharge planning experience in acute care preferred.

Responsibilities

• Act as a key member of the patient care delivery team and manage case plans.
• Oversee interdisciplinary discharge planning and care coordination.
• Evaluate and adjust care plans based on patient needs and changes in condition.
• Collaborate with committees, task forces and staff meetings.
• Ensure medical necessity criteria are met for level of care and documentation through discharge.
• Perform other duties as needed.

Skills

Case management knowledge

Utilization management

English language proficiency

Spanish preferred

Electronic medical records

Critical thinking

Communication

Multitasking

Organizational skills

Education

Bachelor of Science in Nursing (BSN)

Tools

Microsoft Office Suite

Outlook

Electronic Medical Records (EMR)

Electronic event reporting program

Job description

Job Description

MH: Case Management and Social- ( Unscheduled, Varied Shifts) -

Job Summary: The Case Manager serves as a key member of the patient care delivery team and works efficiently in a fast-paced environment and utilizes clinical expertise, discretion and independent judgment in performing the nursing process (assessment, care planning, intervention, evaluation) within a patient-centered care professional practice model (Duffy's Quality-Caring Model) as it relates to case management functions. Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria (medical necessity) are met for level of care provided and is documented from admission through discharge. Practices in a collaborative healthcare environment to oversee implementation of a well-thought-out interdisciplinary plan of care with an individualized discharge plan that is comprehensive and best meets the continuing healthcare needs of the patient. Reevaluates plan of care and ensures continued appropriateness based on the patients changing needs and condition. Represents nursing as an empowered profession and readily embraces new knowledge, innovations and improvements. Exhibits positivity and serves as an instrumental change agent and expertly minimizes resistance to change in the workforce, clinical practice and operational setting. Engages in opportunities to directly or indirectly influence decision-making for clinical practice by supporting and participating in committees, task forces and staff meetings. Performs other duties as needed.

Education and Experience: Bachelor of Science degree in nursing (BSN) required. Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred.

Knowledge and Skills: Basic knowledge of case and utilization management practice and methodologies and state and federal healthcare regulations and accreditation required. Able to: speak, read and write legibly in English (and Spanish preferred) with professional quality; use computer, printer and software programs necessary to the position, e.g., Microsoft Office Suite, Outlook, electronic medical record, electronic event reporting program. Relate and communicate positively, effectively and exhibit professional behavior at all times; work calmly and respond courteously when under pressure; be assertive and consistent in following policies; teach, and collaborate; accept direction; think critically; work independently with minimal supervision; perform basic math and statistical functions; manage multiple assignments effectively; organize and prioritize workload; problem solve; recall information with accuracy; pay close attention to detail; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the work place; see adequately to read computer screens, medical records, and written documents necessary to position. Mandatory mandatory mandatory Mandatory mandatory mandatory Mandatory mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory Mandatory mandatory