RN Case Manager - Utilization Review

Prime Healthcare; Lynwood (CA); On-site; USD 65,000 - 87,000; Full time

Job summary

St. Francis Medical Center in Los Angeles is seeking an experienced registered nurse to join our care-management team.

This full-time Days role focuses on admission review, care coordination, and discharge planning to ensure safe, cost-effective patient transitions. The ideal candidate has at least 5 years post-graduation nursing experience, RN license, and strong computer skills; CCM or InterQual knowledge is preferred.

Qualifications

• Minimum 5 years' work experience post-graduation from an accredited school of nursing.
• At least one year experience in case management, discharge planning or nursing management.
• Experience and knowledge in basic to intermediate computer skills.

Responsibilities

• Oversee quality and resource management of all admitted patients across the care continuum.
• Promote cost containment and provide leadership to integrate health care providers for seamless care delivery.
• Perform holistic admission and concurrent review of medical records for medical necessity, intensity of service and severity of illness.

Skills

Case management

Discharge planning

Nursing management

Computer skills

Education

RN license

Job description

Overview

St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Obstetrics, Pediatrics, Behavioral Health, and Emergency and Trauma Care. In addition, the hospital offers a broad array of education and outreach programs that advance community health. St. Francis Medical Center is a Comprehensive Stroke Center, STEMI Receiving Center, ED Approved for Pediatrics, Geriatric ED, Level III Neonatal ICU, and Level II Trauma Center. Please visit www.stfrancismedicalcenter.comfor more information. Join an award-winning team of dedicated professionals committed to compassion, quality, and service!

Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required Qualifications:

• Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license
• At least one year experience in case management, discharge planning or nursing management
• Experience and knowledge in basic to intermediate computer skills.

Preferred Qualifications:

• Five years of acute care nursing experience. preferred
• CCM or obtained within 1year
• Knowledge of Milliman Criteria and InterQual Criteria preferred.
• Current BCLS certificate, preferred

Pay Transparency

St. Francis Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time. The current compensation range for this role is $47.20 to $63.45. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories.Know Your Rights:https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf