Case Manager RN

AHMC Healthcare Inc.; Anaheim (CA); On-site; USD 60,000 - 118,000; Full time

Job summary

AHMC Healthcare Inc. is looking for an RN Case Manager to provide coordinated patient care in Anaheim, California. The role requires strong clinical knowledge, communication, and problem-solving skills to ensure effective utilization management. The successful candidate will work collaboratively with healthcare teams to support discharge planning and quality improvement initiatives.

Qualifications

• 2 years Utilization Management/Case Management experience preferred.
• Ability to case manage and increase patient/physician satisfaction.
• Working knowledge of community resources and reimbursement methods.

Responsibilities

• Evaluate admissions, concurrent stay, and discharge readiness.
• Coordinate care with Social Workers and Nursing staff.
• Track outcomes and report findings.

Skills

InterQual knowledge

problem-solving

communication

critical thinking

Education

RN License in the State of California

BSN preferred

Certified Case Manager preferred

Tools

Excel

Word

PowerPoint

Job description

2 months ago Be among the first 25 applicants

The RN Case Manager uses InterQual criteria to evaluate the appropriateness of admissions, concurrent stay and readiness for discharge. She/he assures correct level of care critical, telemetry, acute, observation, for all patients. The Case Manager provides an efficient, coordinated approach to clinical management, with an emphasis on discharge planning, care coordination and utilization management activities for select patient populations across the continuum of programs and services at AHMC. The essential functions of the RN Case Manager require constant collaboration with the Social Workers, Nursing staff, Financial Counselors, Medical Staff to coordinate the care of patients in a proactive manner.

The position requires the full understanding and active participation in fulfilling the mission of AHMC- Anaheim Regional Medical Center. It is expected that the employee demonstrate behavior consistent with the core values. The employee shall support AHMC- Anaheim Regional Medical Center strategic plan and goals and direction of the performance improvement plan.

Education/Training/Experience

• 2 years Utilization Management/Case Management experience preferred in acute care setting.
• Working knowledge of Interqual, Intensity of Service/Severity of Illness criteria.
• Working knowledge of Title XVII and Title XIX.
• Working knowledge of reimbursement related to Medicare, Medi-Cal, Capitation, and Managed Care is required.
• Ability to negotiate orders with the physicians in order to assign alternate levels of care.
• Working knowledge of community resources.
• Working knowledge of methods to resolve patient needs such as discharge planning,
• Home Health, DME and SNF’s.
• Ability to case manage smoothly and increase patient/physician satisfaction while staying within guidelines.
• Ability to track outcomes and report findings.
• Able to problem solve effectively.
• Ability to use clinical knowledge to identify potential quality issues, delays in service, post-acute care needs required.
• Must have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, and positive personal influence and negotiation skills.
• Must have strong clinical assessment and critical thinking skills necessary to provide utilization review/discharge planning services appropriate to patients with complex medical, emotional and social needs.
• Must have the ability to work in a high volume caseload environment and deal effectively with rapidly changing priorities.
• Excellent computer skills with word, excel and power point.
  
  
  

Licenses/Certifications

• RN License in the State of California required.
• BSN preferred.
• Certified Case Manager preferred.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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