RN Case Manager: Care Coordination & Transitions

PIH Health; Whittier (CA); On-site; USD 95,000 - 125,000; Full time

Job summary

PIH Health in California is seeking an experienced RN Case Manager to lead care coordination across nursing, physicians, and allied disciplines, ensuring timely progression of patients through the care continuum.

You will oversee discharge planning, determine appropriate level of care beyond acute care, and provide decision support to patients and families while aligning with reimbursement requirements.

Qualifications

• Active California RN license.
• Minimum of 5 years hospital nursing experience.
• Excellent verbal and written communication.
• Knowledge of medical terminology and third-party reimbursement methodologies.
• Self-motivated and results oriented.
• Sound decision making and prioritization skills.

Responsibilities

• Coordinate care with nursing, physicians and other disciplines to pace care and meet core measures.
• Perform discharge planning determining level of care needs beyond acute care.
• Provide decision support to patients, families and physicians and manage expectations.
• Conduct utilization review to ensure medical necessity and appropriate resource use.

Skills

Verbal communication

Written communication

Organizational skills

Chain of command

Medical terminology

Payer reimbursement

Education

BSN or MSN

CCM or ACM

Job description

PIH Health in California is seeking an experienced RN Case Manager to lead care coordination across nursing, physicians, and allied disciplines, ensuring timely progression of patients through the care continuum.

You will oversee discharge planning, determine appropriate level of care beyond acute care, and provide decision support to patients and families while aligning with reimbursement requirements.