RN Case Manager: Discharge & Utilization Leader

Southern California Hospitals; Culver City (CA); On-site; USD 83,000 - 117,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

Alta Hospital is seeking an RN Case Manager to perform clinical assessment and reassessment of acute care inpatients for utilization review, resource management, and safe discharge planning.

The role requires collaboration with the interdisciplinary team, timely care, and advocacy for patient self-determination. Strong CMS/Medicare knowledge and English communication are essential. Sign-on bonus available and base pay is competitive.

Qualifications

• The candidate must have 1 year of case management or nursing leadership experience.
• Current California RN licensure is required.
• Strong knowledge of patient throughput, care coordination and care planning processes.
• Ability to assess medical stability for discharge and medical necessity for continued hospitalization.
• Computer/EMR proficiency and literacy are essential.
• Familiarity with CMS, Medicare, Medi-Cal and managed care reimbursement.
• Familiarity with Joint Commission, CMS, CDPH requirements.
• Excellent written and verbal communication in English.
• Ability to collaborate across the organization and lead rounds.

Responsibilities

• Collaborate with patient/family and health care team to optimize outcomes.
• Review medical necessity using evidence-based criteria for level of care and LOS.
• Coordinate discharge planning and transitions of care with timely documentation.
• Communicate with payers and escalate issues promptly when needed.
• Assist discharge coordinators with clear instructions and referrals.
• Serve as liaison to medical staff to ensure continuity of services.

Skills

Case management

RN license CA

Care coordination

EMR proficiency

CMS/Medicare knowledge

Regulatory knowledge

Communication skills

Collaboration

Team leadership

BSN (preferred)

CCM (preferred)

Acute case mgmt (preferred)

Allscripts

Care guidelines (Milliman/InterQual)

Bilingual (preferred)

Education

Bachelor of Science in Nursing

Tools

Allscripts Care Management

Milliman Care Guidelines / InterQual

Job description

Alta Hospital is seeking an RN Case Manager to perform clinical assessment and reassessment of acute care inpatients for utilization review, resource management, and safe discharge planning.

The role requires collaboration with the interdisciplinary team, timely care, and advocacy for patient self-determination. Strong CMS/Medicare knowledge and English communication are essential. Sign-on bonus available and base pay is competitive.