Inpatient RN Care Manager - Full Time (10hrs)

If you are interested, please apply online and send your resume to yadeleon@mlkch.org. POSITION SUMMARY The RN Care Manager plays a vital role in supporting the physician and interdisciplinary team to enhance clinical outcomes and patient satisfaction, while managing care costs and providing timely information to payors. This position is key in integrating and coordinating utilization management, care progression, and care transition. The Care Manager is responsible for a designated patient caseload and works diligently to meet patient needs, manage length of stay, and encourage efficient resource use. Key responsibilities include: Facilitating precertification and payor authorization processes. Collaborating on patient care management across the continuum and addressing barriers to efficient care delivery and reimbursement. Utilizing process improvement methodologies to evaluate care outcomes. Coordinating communication with physicians to ensure continuous quality care. This role involves understanding RN scope of practice and adhering to regulations related to Utilization Review and Discharge Planning. The Care Manager partners with medical staff and uses scientific evidence and data to effectively manage patient care throughout their hospitalization, from admission to discharge. This position requires strong dedication to the values and mission of Martin Luther King, Jr. Community Hospital. ESSENTIAL DUTIES AND RESPONSIBILITIES Assessment: Conducts comprehensive assessments to identify intervention opportunities tailored to our patients' psycho-social, cultural, spiritual, and physical needs. Evaluates patients' healthcare needs and goals with a focus on their physical, functional, psychosocial, environmental, and financial circumstances. Completes and documents clinical reviews based on medical necessity and findings per Hospital policies and requirements. Communicates with attending physicians about admissions and resource utilization to maintain quality care standards. Assesses risks for readmission using established criteria. Planning: Applies knowledge of medical necessity and service intensity, incorporating payer requirements in effective discharge planning. Understands patients' clinical conditions and social support to determine the most appropriate care settings post-discharge. Considers socio-economic factors to create individualized transition plans. Engages patients and families in the development of transition plans. Continually collaborates with the interdisciplinary team to adjust care plans based on clinical assessments. Advocates for patients with payers to ensure effective care transitions. Implementation: Coordinates care progression, addressing ongoing patient and family needs. Identifies psychosocial and financial barriers, collaborating with Social Work colleagues as needed. Facilitates transitions to acute and post-acute care settings. Maintains knowledge of clinical requirements and payer networks to aid in creating effective transition plans. Identifies home care and equipment needs at discharge and facilitates palliative or hospice care where necessary. Maintains active communication with care team members to ensure timely and effective care delivery. Proactively addresses system issues that may delay care or discharge. Coordinates and monitors patient testing and reporting to ensure seamless care provision. Evaluation Develops case management plans collaboratively with the interdisciplinary team. Evaluates actions for cost-effectiveness, including analysis of length of stay and readmission rates. Utilizes reporting tools to identify and address obstacles to care progression. Communication/Collaboration: Acts as a liaison among the interdisciplinary care team, community providers, payers, and families to ensure effective care transitions. Ensures communication with Patient Financial Services to support accurate billing processes. Collaborates with care team members to resolve barriers and promote efficient care delivery. Participates in patient conferences and family meetings. Provides support and expertise related to patient care issues. Maintains communication with management regarding patient care status and system challenges. Reports any medical/legal issues to appropriate parties. Facilitates discussions to evaluate medical necessity in complex cases. Utilizes conflict resolution skills to address issues promptly. Professionalism: Continuously assesses and improves self-knowledge and competencies within the nursing scope. Participates in departmental meetings and shares case management knowledge. Demonstrates understanding of Medicare discharge planning guidelines and financial communication. Treats all individuals with respect, upholding patient privacy and confidentiality. Shows concern and care for all customers, regardless of socioeconomic status or diagnosis. Maintains positive relationships in the workplace. May perform other related duties as assigned. POSITION REQUIREMENTS A. Education Bachelor's degree in nursing preferred. Associate's degree in Nursing required. B. Qualifications/Experience One (1) to three (3) years of relevant hospital or related experience is required. Internal candidates with at least 18 months of acute care case management experience will be considered. Must be able to effectively network with external provider systems (Health Plans, IPAs, FQHCs). C. Special Skills/Knowledge Bilingual skills preferred (Spanish), along with basic computer proficiency. Current California Nursing license is essential. Current Basic Life Support (BLS) certification required. Certification in Case Management is preferred. ED Care Managers must complete the Workplace Violence Prevention Program within the specified time frame. #LI-YD1