RN Case Manager - Full Time, Days (Tustin)

Prospect Medical Holdings, Inc.; Tustin (CA); On-site; Full time

Job summary

Prospect Medical Holdings, Inc. is seeking an RN Case Manager to join their team. This full-time position involves clinical assessments, care coordination, and collaboration with the healthcare team to ensure safe and effective patient transitions. With a sign-on bonus and a competitive salary range, this role offers the opportunity to influence patient care positively.

Qualifications

• One year of case management experience or nursing leadership experience.
• In-depth knowledge of patient throughput and care planning processes.
• Ability to assess medical stability for discharge.

Responsibilities

• Perform clinical assessments of patients for care coordination.
• Collaborate with healthcare teams to optimize discharge planning.
• Monitor resource utilization and ensure timely care delivery.

Skills

Communication

Patient Care Coordination

Clinical Assessment

Education

Current Licensure as a Registered Nurse in California

Bachelor of Science in Nursing

Job description

RN Case Manager - Full Time, Days (Tustin)

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RN Case Manager - Full Time, Days (Tustin)

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Prospect Medical Holdings, Inc. provided pay range

This range is provided by Prospect Medical Holdings, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$48.40/yr - $66.50/yr

Job Description

The RN Case Manager is responsible for performing clinical assessment and reassessment of acute care Inpatients for the purpose of performing utilization review, resource management and safe discharge planning. The RN Case Manager prioritizes, plans, organizes, and implements timeliness of care. Collaborates with the interdisciplinary healthcare team to promote and coordinate the delivery of safe and cost-effective patient care, transition of care and discharge planning. The RN Case Manager advocates for patient self-determination and choice. Practices clinical competence in evaluations and planning with awareness and respect for patient and family diversity. Monitors and coordinates resource utilization throughout the continuum of care and evaluates timeliness of services. Performs admission, continued stay and discharge review utilizing medical staff-approved decision support criteria.

Responsibilities

$25,000 Sign-on Bonus

• Collaborates as needed with the patient and family to optimize client outcomes. May include work with community, local and state resources, primary care provider, and members of the health care team, payer, and other relevant health care stakeholders to facilitate appropriate patient transfers, discharges and transitions of care. Identifies timely and effective alternative lower level of care settings for patient care in accordance with the patient’s medical necessity, stability, the patients’ preferences and health plan benefits. Identifies timely post-hospital needs and arranges for services as appropriate. Provides patient and family appropriate resources and/or referrals. Makes timely and appropriate referrals to, and seeks consultation with others when needed, the patient-centered provision of services; such as Social Services (i.e., Durable Power of Attorney).
• Reviews medical necessity utilizing medical staff-approved evidence-based decision support criteria. to determine appropriate level of care and length of stay. Ensures utilization review is completed and documented concurrently, and provided to the patient’s payer as required. Ensures timely escalation of unresolved care coordination issues to the appropriate level. Enters delays in service and avoidable days regarding exceeded payer LOS variances. Communicates denials and physician related utilization management practices to immediate supervisor same day as identified.
• Collaborates with patients/caregivers to set goals consistent with physician treatment plans, and patient resources and choices. Collaborates with the multidisciplinary team for timely discharge planning assessments and reassessments and documents concurrently in the patient's medical record in compliance with hospital policy and all regulatory agencies. Provides appropriate instructions to discharge care coordinators as needed.
• Acts as an effective liaison to medical staff to ensure continuity and congruity of hospital services in accordance with the patient’s plan of care.
• Participates in patient and family meetings; respecting and promoting patient choice and documents informed decision making. Utilizes knowledge of psycho-social and physical factors that affect functional status on discharge.
• Contributes requested data for the Utilization Management Committee.
  
  

Qualifications

Required Qualifications:

• One year of case management experience or 1 year nursing leadership experience
• Current Licensure as a Registered Nurse in the State of California
• In-depth knowledge and strong understanding of patient throughput, care coordination, and care planning processes
• Ability to assess medical stability for discharge and evaluate medical necessity for continued acute hospitalization
• Computer/EMR Proficiency and Literacy
• Knowledge of CMS, Medicare, Medi-Cal and Managed Care reimbursement
• Familiarity of Joint Commission, CMS, CDPH requirements
• Excellent written and verbal communication skills in English
• Ability to establish and maintain effective working relationships across the organization
• Ability to facilitate and lead interdisciplinary rounds
  
  

Preferred Qualifications:

• Bachelor of Science in Nursing
• Certified Case Manager (CCM)
• Acute Hospital Case Management Experience
• Familiarity with AllScripts Care Management
• Proficiency with Milliman Care Guidelines or Interqual
• Bilingual skills to communicate effectively with patients and families
  
  

Pay Rate: Min - $48.40| Max - $66.50

$25,000 Sign-on Bonus

Sign-on Bonus Eligibility: To be eligible for the Sign-On Bonus, you must have one or more years of experience in the role for the position posted. Some restrictions and exceptions may apply. Current Hospital employees are not eligible and former Hospital employees may not be eligible. The Sign-on Bonus Program is only available for full-time regular positions. Bonus payments are made in increments over the course of 24 months to active employees in good standing.

About Us

Foothill Regional Medical Center is a fully accredited acute care hospital, licensed for 177 beds—120 beds for general acute care, 15 intensive care beds and 42 pediatric sub-acute beds. Our pediatric sub-acute unit, just one of six in California, serves patients from throughout the state. We care for patients up to 21 years of age who need long-term sub-acute care including ventilator care and nutritional support.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care, Medical Practices, and Mental Health Care

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