RN Case Manager - Care Coordination - Part Time 8 Hours Day Shift (7:30 AM to 4:00 PM) (Union, Non-Exempt)

Keck Medicine of USC; Arcadia (CA); On-site; USD 95,000 - 130,000; Full time

Job summary

Keck Medicine of USC is seeking a Case Manager to support physicians and the interdisciplinary team in delivering high-quality patient care while managing costs and ensuring payer authorization.

The role combines utilization management, care facilitation, and discharge planning for a designated patient caseload, with a focus on timely care delivery and accurate documentation to support reimbursement.

Qualifications

• Associate's degree in nursing is required.
• RN license in CA (CA Board of Registered Nursing) is required.
• Experience with discharge planning, utilization management, and case management is preferred.

Responsibilities

• Coordinate utilization management, care facilitation, and discharge planning.
• Collaborate with physicians, payers, and patients to remove barriers to timely care.
• Document clinical information accurately to support reimbursement and coding.
• Provide a clinical resource for coders and ensure documentation reflects severity of illness.

Skills

Independent work

Interpersonal skills

Time management

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing (preferred)

Job description

The purpose of the Case Manager position is to support the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include: facilitation of pre-certification and payer authorization processes, facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement, application of process improvement methodologies in evaluating outcomes of care support and coaching of clinical documentation efforts and serving as a clinical resource for coders, ensuring that documentation accurately reflects severity of illness and intensity of service coordinating communication with physicians.

Minimum Education: Associate’s Degree Nursing Minimum Skills: Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families. Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement. Excellent interpersonal communication and negotiation skills. Strong organizational and time management skills, as evidenced by a capacity to prioritize multiple tasks and role components. Understanding of pre-acute and post-acute venues of care and post-acute community resources. Strong analytical, data management, and PC skills. Required Certifications: Registered Nurse - RN (CA Board of Registered Nursing) Basic Life Support (BLS) Healthcare Provider from American Heart Association Workplace Violence Training Program Preferred Education: Bachelor’s Degree Nursing Preferred Experience: 3 years Clinical experience in Utilization Review and Discharge Planning in an Acute Hospital strongly preferred.