RN Case Manager

Los Robles Hospital and Medical Center; Thousand Oaks (CA); On-site; USD 85,000 - 121,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) plan with match

Tuition assistance/education support

Employee Stock Purchase Plan

Job summary

HCA Healthcare, Inc. is seeking a Case Manager II to organize and coordinate services for patients, ensuring appropriate utilization of the health care system and quality care across the care continuum. The role spans pre-entry to exit phases, coordinating with hospital staff and external resources.

The position emphasizes discharge planning, referrals, and care coordination with emphasis on cost containment and patient quality of life.

Qualifications

• Associate Degree in Nursing is required.
• Bachelor’s degree in Nursing is preferred.
• Current licensure as a Registered Nurse in California.
• Minimum 2 years of case management experience or 3+ years of clinical nursing experience.
• InterQual experience is preferred.

Responsibilities

• Perform admission review to determine appropriateness and medical necessity per criteria and provide payor reviews as requested.
• Maintain a system for monitoring admissions and ensure timely concurrent reviews.
• Provide referrals related to medical necessity, utilization, quality, or risk management and coordinate ongoing care with hospital staff, physicians, and services.
• Plan, coordinate, and facilitate discharge needs including Home Health, DME, placement, community resources, and hospice care.

Skills

Case management experience

Clinical nursing experience

RN licensure in CA

InterQual experience

Education

Associate Degree in Nursing

Bachelor’s degree in Nursing

Job description

Hourly Wage Estimate: 61.84 - 87.93 / hour

Learn more about the benefits offered for this job.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

As the nation’s largest private employer of Registered Nurses, we’re honored by the trust of over 100,000 nurses and committed to supporting safe, high-quality care for which they can practice. That’s why more than 80% of our hospitals earn an A or B Leapfrog safety grade, rank in the top 5% nationally for patient outcomes through Health Grades, or are recognized as Magnet or Pathway to Excellence facilities.

Job Summary and Qualifications

The Case Manager II will be organizing and coordinating services and resources to meet patient's healthcare needs; ensures appropriate use of the health care system; utilizes a process that will provide quality care along a continuum, decrease fragmentation of care across many settings, enhance patient’s quality of life and contain costs. Accomplishes these objectives through review and coordination of patient care during the pre-entry, entry, within the organization, pre-exit, and exit phases.

• You will be performing admission review to determine appropriateness and medical necessity based on approved criteria and standards and providing payors with admission and concurrent reviews as requested
• You will be maintaining system for monitoring all admissions and assure timely concurrent reviews
• You will be making appropriate referrals related to medical necessity, utilization, quality, or risk management and coordinating on-going care and utilization with hospital staff, physicians, ancillary services, and patient
• You will plan, coordinate, and facilitate all discharge needs for patients including Home Health, DME, placement, community resources, and hospice care

Qualifications:

• AssociateDegreeinNursing Required
• Bachelor’s degree in Nursingpreferred
• Current licensure as a Registered Nurse in the state of California
• Minimum 2 years experience in case management or 3+ years experience in clinical nursing (Medical-Surgical, ICU or ED preferred)
• InterQualexperiencePreferred

Benefits

Los Robles Regional Medical Center offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

"There is so much good to do in the world and so many different ways to do it." - Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder

Los Robles Regional Medical Center is a 380+ bed acute care hospital dedicated to serving the residents of Ventura and Los Angeles Counties along with the Greater Conejo Valley. We are the only Level II Trauma Center in East Ventura County. We are known for providing excellent care with compassion and kindness to each of our patients. In addition, Los Robles Regional Medical Center features a 24-hour emergency department, comprehensive stroke center, ICU/CCU, maternity, Level III NICU, comprehensive cancer center, heart & cardiovascular center, same day surgery, and rehab center.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

Be a part of an organization that leverages our size to make a real impact in our industry! Our Talent Acquisition team is reviewing applications for our RN Case Manager opening.

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.