Managed Care Lead Case Management

Torrance Memorial Medical Center; Torrance (CA); On-site; USD 81,000 - 126,000; Full time

Job summary

Torrance Memorial Medical Center is seeking a Lead Case Manager to oversee the hospital census and ensure swift transitions of care. The role educates case managers on health plans and regulatory changes, and collaborates with discharge planners and post-acute providers to optimize outcomes.

The Lead participates in peer review, mentors staff, and ensures compliance with CMS discharge planning requirements. Five years of acute care case management experience and an RN license are required.

Qualifications

• Bachelor's degree in Nursing with RN licensure.
• Minimum of 5 years of case management experience in an acute care setting.
• Registered Nurse license with BLS or ACLS certification.

Responsibilities

• Oversee daily hospital census to ensure timely transitions of care.
• Educate case managers on health plans and regulatory changes.
• Collaborate with health plan case managers and discharge planners.
• Monitor length of stay and secure post-acute authorization.

Skills

Peer Review

Preceptor

Patient Education

Magnet Model

Quality Metrics

Discharge Planning

Utilization Review

Chart Review

Bed Utilization

Education

Bachelor's degree in Nursing

Job description

The Lead Case Manager is responsible for assisting with the daily oversight of the hospital census to ensure effective and timely transitions of care. The Lead assists with the oversight of regulatory compliance processes and staff compliance with policies and procedures.

The Lead develops collegial relationships with the interdisciplinary team leads. The Lead educates case managers regarding health plans and regulatory changes related to transitions of care. This position provides feedback to staff to support well-coordinated care amongst the interdisciplinary team and post-acute providers. The lead monitors the length of stay to assist the team in securing authorization for the patient’s post-acute care through collaboration and communication with the health plan case managers and discharge planners. This position adheres to the CMS condition of Participation for Discharge Planning and other regulatory requirements

Core Competencies

• Participates in Peer Review, Professional Development activities and acts as preceptor.
• Provides patient and family education throughout the care of patient.
• Participates in activities in alignment with the Magnet Model.
• Complies with organizational quality dashboard benchmarking goals.
• Makes daily work assignments for each Case Manager.
• Attends Revenue cycle meeting monthly.
• Utilizes experience, in-depth knowledge to effectively modify and document changes in nursing care and/or the plan of care to address patient care problems and keep the primary care provider updated on any changes. Assesses health needs of patients using specialized knowledge skills and anticipates the outcome of interventions.
• Collaborates with the Utilization Review Nurse to expedite discharges and screen admission requests.
• Performs chart review and quality assessments as directed.
• Identifies inappropriate bed utilization and quality of care problems and refers them to Utilization Management physician advisor.

Education

Degree Bachelors

Program Nursing

Experience

Number of Years Experience 5

Type of Experience Case Management

Additional Information Five years clinical experience in an acute care facility.

License / Certification Requirements

Registered Nurse License

BLS or ACLS Certification

Compensation Range:

$58.54 - 91.82 / Hour