RN Case Manager: Care Transitions & Utilization

Antelope Valley Medical Center; Lancaster (CA); On-site; USD 66,000 - 109,000; Full time

Job summary

Antelope Valley Medical Center in Lancaster, CA is seeking an RN Case Manager to prioritize and monitor patient progress, assess medical care needs, and promote continuity of care within the hospital system. The role includes oversight of discharge planning and utilization review to ensure appropriate care and resource use.

The RN Case Manager will guide discharge coordinators, coordinate with physicians, and ensure accurate documentation for payors while advocating for patients throughout the

Qualifications

• RN required with case management experience.
• Ability to plan and coordinate patient care across transitions.
• Knowledge of Medicare, Medi-Cal, CCS and related payer rules.

Responsibilities

• Identify care levels and coordinate cost-effective services.
• Support discharge planning and documentation.
• Communicate with physicians and staff to optimize utilization.
• Provide and review clinical information to support appropriate care levels.
• Monitor authorizations and payer requirements for discharge planning.
• Utilize HDM and LING systems to trigger discharge planning.
• Assist with data analysis to identify trends in utilization.
• Advocate for patients in all clinical, social, financial, and ethical matters.

Skills

Case management

Discharge planning

Utilization review

Nursing

Communication

Education

Two-year nursing degree

Bachelor’s degree in nursing

Tools

HDM system

LING system

PCC Physician Advisor

InterQual criteria

Job description

Antelope Valley Medical Center in Lancaster, CA is seeking an RN Case Manager to prioritize and monitor patient progress, assess medical care needs, and promote continuity of care within the hospital system. The role includes oversight of discharge planning and utilization review to ensure appropriate care and resource use.

The RN Case Manager will guide discharge coordinators, coordinate with physicians, and ensure accurate documentation for payors while advocating for patients throughout the