Discharge & Utilization Case Manager RN

NALHE; San Diego (CA); On-site; USD 85,000 - 105,000; Full time

Job summary

NALHE is seeking a collaborative healthcare professional to coordinate admissions and post-hospital care planning with physicians, families, and the multidisciplinary team. You will act as an advocate, ensuring safe, cost-effective discharge plans while maintaining high-quality patient care.

You will coordinate transfers, ensure compliance with regulatory standards, and participate in care planning rounds to optimize resource use and patient outcomes in a fast-paced environment.

Responsibilities

• Plans, develops, assesses and evaluates care provided to members.
• Collaborates with physicians, other multidisciplinary health care team members and patient/family to develop, implement and document appropriate, individualized care plans to ensure continuity, quality and resource use.
• Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
• Assesses high risk patients in need of post-hospital care planning.
• Develops and coordinates the implementation of a discharge plan to meet patients identified needs.
• Communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies.
• Reviews, monitors, evaluates and coordinates the patient’s hospital stay to ensure timely and efficient delivery of services.
• Participates in Bed Huddles and implements recommendations aligned with patient needs.
• Coordinates interdisciplinary care, including Utilization management, Transfer coordination, and Discharge planning with authorizations for outside services.
• Conducts daily clinical reviews for utilization/quality management across settings (outpatient, ER, inpatient, and non-KFH facilities).
• Acts as liaison between in-patient facilities and referral facilities/agencies, providing case management to referred patients.
• Refer patients to community resources to meet post-hospital needs.
• Coordinates transfer of patients to appropriate facilities and maintains required documentation.
• Adheres to regulatory/accreditation requirements (TJC, DHS, HCFA, CMS, DMHC, NCQA, DOL) and compliance guidelines.
• Educates healthcare team on discharge planning roles and resource use; provides patient education to aid discharge and coping with illness.
• Reports any incidents related to quality, risk, or patient safety per established protocols; participates in data collection for studies and monitoring.
• Coordinates care planning rounds and family conferences; participates in committees or other projects as assigned.

Job description

NALHE is seeking a collaborative healthcare professional to coordinate admissions and post-hospital care planning with physicians, families, and the multidisciplinary team. You will act as an advocate, ensuring safe, cost-effective discharge plans while maintaining high-quality patient care.

You will coordinate transfers, ensure compliance with regulatory standards, and participate in care planning rounds to optimize resource use and patient outcomes in a fast-paced environment.