Prospect Medical Holdings, Inc.
Case Manager RN - Loan Forgiveness - Full Time, Days (Culver City)
Prospect Medical Holdings, Inc., Culver City, California, United States, 90232
Case Manager RN - Loan Forgiveness - Full Time, Days (Culver City)
Join to apply for the
Case Manager RN - Loan Forgiveness - Full Time, Days (Culver City)
role at
Prospect Medical Holdings, Inc. Job Description
The RN Case Manager is responsible for performing clinical assessment and reassessment of acute care Inpatients for 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 safe, cost-effective patient care, transition of care, and discharge planning. Advocates for patient self-determination and respects 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 using medical staff-approved decision support criteria. Responsibilities
Collaborates with patients and families to optimize outcomes, working with community and healthcare resources to facilitate appropriate transfers, discharges, and transitions. Identifies lower level of care options based on medical necessity and patient preferences. Provides resources and referrals, and makes timely referrals to social services and other relevant providers. Reviews medical necessity using approved criteria to determine appropriate care levels and lengths of stay. Ensures utilization review is documented and communicated to payers. Escalates unresolved issues promptly and communicates denials and management practices to supervisors. Works with patients and caregivers to set goals aligned with treatment plans, documenting assessments and providing discharge instructions. Acts as a liaison to ensure continuity of hospital services and participates in patient and family meetings, respecting patient choices. Contributes data for the Utilization Management Committee as needed. Qualifications
Required: One year of case management or nursing leadership experience Current RN licensure in California Knowledge of patient throughput, care coordination, and planning processes Ability to assess medical stability and evaluate necessity for continued hospitalization Proficiency in EMR and computer skills Understanding of CMS, Medicare, Medi-Cal, and Managed Care reimbursement Familiarity with Joint Commission, CMS, and CDPH requirements Effective communication skills in English Ability to work collaboratively across teams Facilitation and leadership skills for interdisciplinary rounds Preferred: Bachelor of Science in Nursing Certified Case Manager (CCM) Experience in acute hospital case management Familiarity with AllScripts Care Management, Milliman Care Guidelines, or Interqual Bilingual skills Pay Range:
Min - $58.32 | Max - $82.48 Sign-on Bonus:
$25,000, eligibility criteria apply, paid over 24 months. About Us
Southern California Hospital at Culver City provides comprehensive acute care services with a focus on safety and modern treatments. The hospital features a 24/7 emergency department, inpatient and outpatient services, and specialized centers including orthopedics and cardiovascular care.
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Join to apply for the
Case Manager RN - Loan Forgiveness - Full Time, Days (Culver City)
role at
Prospect Medical Holdings, Inc. Job Description
The RN Case Manager is responsible for performing clinical assessment and reassessment of acute care Inpatients for 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 safe, cost-effective patient care, transition of care, and discharge planning. Advocates for patient self-determination and respects 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 using medical staff-approved decision support criteria. Responsibilities
Collaborates with patients and families to optimize outcomes, working with community and healthcare resources to facilitate appropriate transfers, discharges, and transitions. Identifies lower level of care options based on medical necessity and patient preferences. Provides resources and referrals, and makes timely referrals to social services and other relevant providers. Reviews medical necessity using approved criteria to determine appropriate care levels and lengths of stay. Ensures utilization review is documented and communicated to payers. Escalates unresolved issues promptly and communicates denials and management practices to supervisors. Works with patients and caregivers to set goals aligned with treatment plans, documenting assessments and providing discharge instructions. Acts as a liaison to ensure continuity of hospital services and participates in patient and family meetings, respecting patient choices. Contributes data for the Utilization Management Committee as needed. Qualifications
Required: One year of case management or nursing leadership experience Current RN licensure in California Knowledge of patient throughput, care coordination, and planning processes Ability to assess medical stability and evaluate necessity for continued hospitalization Proficiency in EMR and computer skills Understanding of CMS, Medicare, Medi-Cal, and Managed Care reimbursement Familiarity with Joint Commission, CMS, and CDPH requirements Effective communication skills in English Ability to work collaboratively across teams Facilitation and leadership skills for interdisciplinary rounds Preferred: Bachelor of Science in Nursing Certified Case Manager (CCM) Experience in acute hospital case management Familiarity with AllScripts Care Management, Milliman Care Guidelines, or Interqual Bilingual skills Pay Range:
Min - $58.32 | Max - $82.48 Sign-on Bonus:
$25,000, eligibility criteria apply, paid over 24 months. About Us
Southern California Hospital at Culver City provides comprehensive acute care services with a focus on safety and modern treatments. The hospital features a 24/7 emergency department, inpatient and outpatient services, and specialized centers including orthopedics and cardiovascular care.
#J-18808-Ljbffr