RN Er

Tustin, CA - USA

Hourly Salary: $ 48 - 72

Posted on: 9 hours ago

Vacancies: 1 Vacancy

Job Summary

The RN 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. The RN Case Manager 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. The RN Case Manager 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 decision support criteria.

Our Values:

Put Patients First
Empower Entrepreneurial Provider and Care Teams
Operate with Integrity & Excellence
Be Innovative
Work As One Team

What Youll Do

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 patients 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 patients 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 physician treatment plans and patient resources and choices. Collaborates with the multidisciplinary team for timely discharge planning assessments and reassessments and documents concurrently in the patients 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 patients 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.

Qualifications

One year of case management experience or 1 year nursing leadership experience

Current Licensure as a Registered Nurse in the State of California

In-depth knowledge and strong understanding of patient throughput care coordination and care planning processes

Ability to assess medical stability for discharge and evaluate medical necessity for continued acute hospitalization

Computer/EMR Proficiency and Literacy

Knowledge of CMS Medicare Medi-Cal and Managed Care reimbursement

Familiarity of Joint Commission CMS CDPH requirements

Excellent written and verbal communication skills in English

Ability to establish and maintain effective working relationships across the organization

Ability to facilitate and lead interdisciplinary rounds

Preferred Qualifications:

Bachelor of Science in Nursing

Certified Case Manager (CCM)

Acute Hospital Case Management Experience

Familiarity with AllScripts Care Management

Proficiency with Milliman Care Guidelines or Interqual

Bilingual skills to communicate effectively with patients and families

Environmental Job Requirements and Working Conditions

The base pay range for this role is $48 - $72 per hour. This salary range represents our national target range for this role.
This role follows an onsite work structure where the expectation is to work 5 days in office. The office is located at 14662 Newport Ave Tustin CA.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race religion color national origin gender (including pregnancy childbirth or related medical conditions) sexual orientation gender identity gender expression age status as a protected veteran status as an individual with a disability or other applicable legally protected characteristics. All employment is decided based on qualifications merit and business need. If you require assistance in applying for open positions due to a disability please email us at to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Put Patients First
Empower Entrepreneurial Provider and Care Teams
Operate with Integrity & Excellence
Be Innovative
Work As One Team