Managed Care Lead Case Management

Torrance Memorial; Torrance (CA); On-site; USD 80,000 - 127,000; Full time

Job summary

Torrance Memorial is seeking a Lead Case Manager to oversee hospital census and ensure timely transitions of care in a high-acuity setting. You will lead the interdisciplinary team, educate case managers on health plans and regulatory changes, and coordinate with discharge planners to optimize post-acute authorization.

Responsibilities include monitoring length of stay, guiding staff per CMS discharge planning requirements, and maintaining collaboration with Utilization Review and physicians to

Qualifications

• BSN required and RN license.
• BLS or ACLS certification.
• Minimum five years of clinical experience in an acute care setting.
• Experience in case management and discharge planning.

Responsibilities

• Assist daily oversight of hospital census and transitions of care.
• Oversee regulatory compliance processes and staff adherence to policies.
• Develop relationships with interdisciplinary team leads.
• Educate case managers on health plans and regulatory changes.
• Monitor length of stay and secure post-acute authorization with health plans.
• Adhere to CMS Discharge Planning and related regulations.

Skills

Case management

Interdisciplinary collaboration

Education for patient/family

Regulatory compliance

Discharge planning

CMS standards familiarity

Education

Bachelor's in Nursing

Job description

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 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

DegreeProgramBachelorsNursing

Experience

ExperienceNumber of Years ExperienceType of Experience5Case Management

Additional InformationFive years clinical experience in an acute care facility.

License / Certification Requirements

Registered Nurse LicenseBLS or ACLS Certification

Compensation Range

$58.54 - 91.82 / Hour