Case Manager RN Specialty Training - Loan Forgiveness - Full Time, Days (Norwalk)

The RN Specialty Training 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. 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. 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 evidence- based decision support criteria.

• 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 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.

Los Angeles Community Hospitals at Norwalk

Required Qualifications:

• Active, current, and unencumbered Licensure as a Registered Nurse in the State of California
• Graduate of an Accredited School of Nursing
• Six months of nursing experience in an acute care setting and completion of Case Management specific hospital training program
• Computer/EMR Proficiency and Literacy
• Ability to read, write and communicate effectively in English
• Ability to work variable shifts including weekends and holidays
• Ability to maintain flexibility and composure in a constantly changing environment
• Hospital Fire and Life Safety Card (Hollywood and Van Nuys Employees only)
• Excellent written and verbal communication skills in English

Preferred Qualifications:

• Previous Case Management Experience
• Bachelor of Science in Nursing
• Familiarity with Allscripts Care Management
• Proficiency with Milliman Care Guidelines or Interqual
• Bilingual skills to communicate effectively with patients and families

Pay Rate: Min - $43.90 | Max - $60.30