ED Registered Nure (RN) Access Case Manager, 12HR, 2pm - 2am

PIH Health; Lynwood (CA); On-site; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated RN ED Access Case Manager to enhance patient care coordination within their emergency department. This role emphasizes collaboration with nursing staff, physicians, and other key disciplines to ensure seamless admissions and transfers to the appropriate level of care. You will play a critical role in managing hospital resources and facilitating effective communication with patients and their families. If you're passionate about improving patient outcomes and thrive in a dynamic healthcare environment, this opportunity is perfect for you.

Qualifications

• Expertise in care coordination and utilization review for patient admissions.
• Strong communication skills for effective patient and family interactions.

Responsibilities

• Coordinate admissions and transfers to ensure appropriate patient placement.
• Perform utilization reviews to achieve service authorization and reimbursement.

Skills

Care Coordination

Utilization Review

Patient Communication

Collaboration with Healthcare Teams

Education

Registered Nurse License

Bachelor's Degree in Nursing

Tools

Hospital Bed Control System

Insurance Coordination Tools

Job description

The RN ED Access Case Manager provides care coordination which emphasizes positive partnerships with nursing, physicians, and other key disciplines in order to coordinate admissions, transfers, and repatriation to PIH Health Hospitals through the emergency room or direct admission. The RN ED Access Case Manager works closely with insurance and various payors to coordinate and assist with repatriation/transfer of out-of-network patients from PIH Health Hospitals to the patient’s contracted facility.

The RN ED Access Case Manager performs utilization review with a high level of expertise by using criteria that demonstrates medical necessity to achieve authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, Outpatient). The RN ED Access Case Manager also provides oversight of the hospital bed control system and works in collaboration with the House Supervisor to ensure appropriate placement of patients to the right level of care. The RN ED Access Case Manager works to ensure appropriate utilization of hospital resources in all settings and levels of care.

The RN ED Access Case Manager is also responsible for completing discharge orders of patients discharged from the emergency department. Works closely with Care Management Coordinators in arranging delivery of DMEs, post-emergency visit care including but not limited to coordinating discharges to SNFs, Subacutes, LTACs, Hospice, Home with and without home health services, or arranging various follow-up appointments. Communicates effectively with patients, families, and other healthcare teams as necessary about various care coordination of patients in the emergency department of PIH Health Hospitals.