RN Case Manager - Medical Network Care Transitions

Case Management Society of America (CMSA) ®; Los Angeles (CA); On-site; Full time

Job summary

Join a prestigious medical center ranked #1 in California as an RN Care Coordinator. This role focuses on managing patient care processes from admission to discharge. You will assess patients, ensure care quality, and communicate with various healthcare teams to facilitate effective transitions. A supportive environment awaits with competitive pay and excellent benefits.

Benefits

Health and dental insurance

403(b)

Vacation

Qualifications

• 3 years of acute nursing experience required.
• 1 year of previous experience in case management preferred.

Responsibilities

• Conducts initial assessments and coordinates care.
• Communicates with health plans for service appropriateness.
• Plans discharges and coordinates outpatient follow-up.

Skills

Patient Assessment

Care Coordination

Communication

Education

Graduation from an accredited school of nursing

Bachelor of Science in Nursing degree

Job description

Job Description

Join Cedars-Sinai!

Cedars-Sinai Medical Center has been ranked the #1 hospital in California and #2 hospital in the nation by U.S. News & World Report, 2022 ? 23

Cedars-Sinai was awarded the Advisory Board Company?s Workplace of the Year which is an award that recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We also have a great benefits package and competitive compensation which explains why U.S. News & World Report has named us one of America?s Best Hospitals!

Why work here?

Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) we take pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation.

A Little More About What You Will be Doing

The RN Care Coordinator is responsible for the case management of patient while hospitalized and upon discharge from various care settings. In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the RN Care Coordinator will assist patients from the time they are admitted until they are discharged from the hospital by assessing their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered and to ensure that quality care is delivered in a cost-effective manner.

Job duties and responsibilities:

• Meets with patients within 24 hours of admission and conducts an initial assessment.
• Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patient?s stay.
• Reviews with hospitalist the patient?s admission and continued stay for medical necessity, appropriateness of care and level of care. Use Milliman and InterQual guidelines as necessary.
• Plans for discharges and care assessments.
• Submits necessary clinical information to the health plan using the accepted format and coordinate health plan communication with assigned hospitalist as appropriate.
• Coordinates with Nurse Practitioners and ISP Hospitalists assigned to the SNF?s for continued review and follow up.
• Communicates transition of care to the member or responsible party including: i) Transition process and what to expect ii) Changes in health status and the care plan iii) Staff who will be handling issues, questions, concerns, i.e. Care Coordinator.
• Authorizes all appropriate services based upon covered benefits and necessity of care provided in the: a) Member?s home or residence b) Acute Care c) Skilled Nursing Facility d) Rehabilitation Facility e) Home Health Care f) Custodial Care facility or Board and Care Facility.
• Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate.
• Secures outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers.
• Refers to Ambulatory Case Mangers for those patients identified that need oversight of outpatient care and compliance to avoid unnecessary readmissions.
• Coordinates referrals and secures appointments with various CSMNS disease management programs.

Qualifications

Education:

• Graduation from an accredited school of nursing required
• Bachelor of Science in Nursing degree preferred

License/Certifications:

• Valid CA RN license required
• Certified Case Management (CCM) RN preferred

Experience:

• 3 years of acute nursing experience required
• 1 year of previous experience in case management in the acute inpatient or outpatient settings preferred

Req ID : 8851
Working Title : RN Case Manager - Medical Network Care Transitions
Department : MNS Care Transitions
Business Entity : Cedars-Sinai Medical Care Foundation
Job Category : Patient Services
Job Specialty : Case Management
Overtime Status : NONEXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $46.42 - $74.27