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

University of Southern California; Arcadia (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

The Case Manager at University of Southern California roles to support physicians and the care team in delivering quality patient outcomes while managing care costs. It integrates utilization management, care facilitation, and discharge planning to maintain appropriate length of stay and resource use.

The position emphasizes collaboration with payers, clinicians, and families, with responsibility for a designated patient caseload and timely information to support optimal reimbursement and

Qualifications

• Active RN license with CA BRN.
• BLS Healthcare Provider certification.
• Workplace Violence Training required.

Responsibilities

• Facilitate pre-certification and payer authorization processes.
• Coordinate collaborative patient care across the continuum with physicians and payers.
• Identify and remove barriers to timely and efficient care delivery and reimbursement.
• Apply process improvement methodologies to evaluate outcomes of care.
• Coach clinical documentation efforts and serve as a resource for coders to ensure accurate severity of illness and intensity of service.
• Coordinate communication with physicians and care teams to optimize discharge planning and resource utilization.

Skills

Discharge Planning

Utilization Management

Interdisciplinary Collaboration

Communication Skills

Time Management

Data Management

Education

Associate's Degree Nursing

Bachelor's Degree Nursing

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.