RN, Case Manager III (UR)

MemorialCare Health System

Long Beach (CA)

On-site

USD 85,000 - 120,000

Full time

3 days ago

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Benefits offered by this job

Signing bonus $20,000

Job summary

Long Beach Memorial Medical Center in California is seeking a RN Case Manager III (UR) to plan, coordinate, and facilitate discharge planning for a caseload of patients across the continuum of care.

The Case Manager III collaborates with the care team, patients, and families to ensure safe, effective, and cost-conscious outcomes. A BSN or health-related degree is preferred, with 3–5 years of acute care or home health experience.

Qualifications

Requires strong verbal and written communication with diverse backgrounds.
Knowledge of criteria for medical necessity across continuum of care; familiarity with MediCal/Medicare and managed care.
Three to five years acute care or home health plus prior experience in Quality Improvement, Case Management, Discharge Planning or Utilization Management.

Responsibilities

Independently manage a caseload of patients and coordinate discharge planning.
Collaborate with health care team, patient, and family to achieve expected outcomes.
Monitor utilization and evaluation of medical outcomes; ensure appropriate documentation and education.
Coordinate across departments to optimize resources and quality outcomes.
Communicate with nursing leadership and Medical Directors on quality issues.

Skills

Communication

Care coordination

Discharge planning

Utilization management

Education

BSN or Bachelor's degree in health or related field

Job description

Job Description - RN, Case Manager III (UR) (LON015715)

Job Description

Description

LocationLong Beach

DepartmentCare Coordination

StatusFull time

ShiftDay

Pay Range$61.98/hr - $86.73/hr

$20,000 signing bonus available to external hires new to MHS employment, contingent upon satisfaction of employment requirements.

At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare.Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability.Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.

Position Summary

The Case Manager III is a licensed professional who plans, coordinates and facilitates the ongoing care and appropriate discharge plan of a specific caseload of patients through the continuum of care. The case manager III collaborates with members of the health care team, the patient, and their family to assure effective, efficient, and appropriate care and outcomes. The incumbent is accountable for education, monitoring, utilization and evaluation of medical outcomes.

Essential Job Outcomes & Functions Care Management

Case Management
The case manager III independently manages a specific case load of patients as identified by the Resource Management Department and CareLines. Thecase manager analyzes patient information and assess each patient’s functional status and decision making ability in relation to the continuum of care and discharge needs. The case manager collaborates with the health care team, patient, and family in planning and facilitating the achievement of expected outcomes for patients. Each treatment plan is evaluated for appropriate quality outcomes and utilization of resources.

Continuum of Care/Quality
The case manager III works collaboratively with the health care team to provide education, resources, and referrals as needed for each patient and their family or caretaker. The case manager facilitates coordination among health care professionals, services, and settings involved in the patient’s care, with a focus on enhancing patient satisfaction. The case manager actively communicates with nursing leadership, CareLine physician directors, and Medical Directors on quality issues. As appropriate, concerns are referred to various Medical Staff Committees and CareLines through required documentation, including but not limited to the Clinical Pertinence Review Form. The case manager has the responsibility to maintain professionalism and provide ongoing education to the health care team regarding the case manager’s role.

Utilization Management
The case manager works collaboratively and proactively with payors in managing patient resources. The case manager assures the hospital receives appropriate reimbursement through collaboration with the health care team and provides timely clinical review, as well as retroactive review for unbilled accounts. The case manager utilizes the billing system to analyze charges vs. reimbursement and contract information. This information is used to structure the health care team toward effective utilization of resources. The case manager incorporates knowledge of medical necessity, CareLine protocols, and MAPs to evaluate for appropriateness of admissions, continued stay, and discharges. The case manager refers cases, as appropriate, for review to the
Combined Resource Management Committee and other Medical Staff Committees as needed.

Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities.Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Qualifications

Experience

This position requires strong verbal and written communication skills with the ability to communicate well with people from diverse socioeconomic backgrounds.
The case manager is knowledgeable of criteria for medical necessity for each level of care through the continuum of care. A knowledge of reimbursement related to MediCare, MediCal, Capitation, and Managed Care is required.
Three to five years acute care or home health experience plus prior experience in Quality Improvement, Case Management, Discharge Planning or Utilization Management required.

Education