Case Manager RN

San Antonio Regional Hospital; Upland (CA); On-site; USD 107,000 - 161,000; Full time

Job summary

San Antonio Regional Hospital is seeking a Registered Nurse to evaluate patients’ clinical status and determine medical necessity for hospitalization and acute care progression. You will use clinical data, prior function, and treatment plans to ensure safe transitions to appropriate care levels.

Applicants should have a nursing degree with CA RN licensure and AHA BLS, plus hospital-based experience. Per diem roles may require 1–2 years of inpatient case management experience.

Qualifications

• Graduate of a nursing program leading to RN licensure.
• Three years’ acute hospital experience preferred; per diem 1-2 years in acute inpatient adult case management may be required.
• Knowledge of common disease processes and reimbursement methodologies; able to prioritize work.
• Current RN licensure in California and a current AHA BLS card.
• Basic computer skills; willingness to learn EMR systems across departments.

Responsibilities

• Evaluate the clinical status of patients using evidence based criteria to determine medical necessity for hospitalization.
• Assess clinical progression and continued acute care needs; support safe transitions to other levels of care.
• Utilize information about clinical condition and anticipated treatment plan to guide discharge planning.

Skills

Clinical judgment

Prioritization

Healthcare reimbursement

EMR systems

Microsoft Word

Education

RN licensure

Nursing degree

Tools

Microsoft Word

Job description

JOB SUMMARY

Evaluates the clinical status of patients using evidence based criteria to determine medical necessity for hospitalization, clinical progression and continued acute care needs. Utilizes information about clinical condition, prior level of functioning and anticipated treatment plan to support a safe, smooth transition to other levels of care.

Overview

Evaluates the clinical status of patients using evidence based criteria to determine medical necessity for hospitalization, clinical progression and continued acute care needs. Utilizes information about clinical condition, prior level of functioning and anticipated treatment plan to support a safe, smooth transition to other levels of care.

Minimum Qualifications

Education: Graduate of a nursing program, leading to RN licensure.

Experience: Three years’ acute hospital experience preferred. Experience in utilization review, discharge planning and/or case management is preferred. For Per Diem positions 1-2 years previous acute inpatient adult case management experience is required.

Knowledge and Skills: Knowledge of common disease processes, knowledge of health care delivery systems, demonstrates understanding of common reimbursement methodologies. Able to manage competing priorities and effectively prioritizes work.

License and Certifications: Current RN licensure in the State of California and a current American Heart Association (AHA) BLS card are required.

Equipment: Basic computer skills with working knowledge of Word. Willingness to learn all aspects of the Business Services, Case Management, Emergency Department and hospital wide electronic medical record systems.

Physical Requirements: Must be able to perform the essential physcial requirements of the job as noted in the job description.

PAY RANGE

$51.58 - $77.36

The posted pay range reflects the lowest to highest pay that was available for this position at the time of posting and may be subject to change. Salary offers are determined by candidate’s relevant experience and skills. For per diem positions, a standard rate is used based on market data and not the candidate’s individual experience.