RN Case Manager - Medical Network Care Transitions

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 Companys 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 Americas 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 patients stay. - Reviews with hospitalist the patients 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 SNFs 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) Members 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.