RN Care Manager: Care Transitions & Payer Coordination

MLK Community Healthcare; Los Angeles (CA); On-site; USD 73,000 - 113,000; Full time

Job summary

MLK Community Healthcare is seeking a dedicated Case Manager to support the physician and interdisciplinary team in coordinating patient care, aiming to improve clinical outcomes and patient satisfaction while managing care costs and providing timely information to payors.

This role integrates utilization management, care progression, and care transition, collaborating with physicians, nurses, social workers and other colleagues to assess needs, plan discharge, arrange post-acute services, and

Qualifications

• Bachelor of Science degree in nursing required or equivalent.
• Current California Nursing license.
• Certification in Case Management preferred.
• Ability to navigate health plan networks and payer requirements.

Responsibilities

• Completes comprehensive assessments to identify intervention opportunities for psycho-social, cultural, spiritual, and physical care.
• Plans safe, effective discharge with consideration of home, SNF, LTACH, or other settings.
• Collaborates with interdisciplinary team to ensure timely care progression and communication with payors.
• Facilitates transfers to post-acute venues and coordinates home care and DME needs at discharge.
• Maintains proactive communication with physicians, nursing staff and payers to support care progression.

Skills

Communication

Interpersonal skills

Organization

Team collaboration

Education

Bachelor of Science in Nursing

Case Management Certification (preferred)

Tools

Electronic Health Records

Basic computer skills

Job description

MLK Community Healthcare is seeking a dedicated Case Manager to support the physician and interdisciplinary team in coordinating patient care, aiming to improve clinical outcomes and patient satisfaction while managing care costs and providing timely information to payors.

This role integrates utilization management, care progression, and care transition, collaborating with physicians, nurses, social workers and other colleagues to assess needs, plan discharge, arrange post-acute services, and