CEDARS-SINAI
RN Care Coordinator - Inpatient Specialty Program
CEDARS-SINAI, Beverly Hills, California, United States, 90211
Overview
Join Cedars-Sinai Cedars-Sinai has been named to the Honor Roll for the ninth consecutive year and tied for #1 in California and Los Angeles in U.S. News & World Report’s “Best Hospitals 2024-25” rankings, as well as placed among the very best in 11 specialties nationwide. Align yourself with an organization that has a reputation for excellence. Cedars-Sinai was awarded multiple national recognitions for providing high-quality medical care and for outstanding employee engagement. This role offers the opportunity to contribute to a culture of innovation and care. Why work here? We offer competitive benefits including health and dental insurance, vacation, and a 403(b). Our staff reflects the diverse community we serve and we are committed to a dynamic, inclusive environment that fuels innovation. Responsibilities
Meets with patients within 24 hours of admission and conducts an initial assessment. Collaborates with the designated hospitalist every day during rounds to discuss disposition planning and assess suitability for each patient’s hospital stay. Reviews with the hospitalist the patient’s admission and ongoing stay for medical necessity, appropriateness of care and level of care. Uses Milliman and Interqual guidelines as necessary. Collaborates with clinical teams to synchronize operations and conducts utilization review as appropriate to match the payor. Investigates, processes, and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and policy. Initiates discharge planning and care assessment within one working day (preferably on day of admission). Submits necessary clinical information to the health plan using the accepted format and coordinates health plan communication with the assigned hospitalist. For patients transitioning to Skilled Nursing Facilities, refers to the nurse practitioner and case manager assigned to the SNF for continued review and follow-up. Authorizes services based on covered benefits and necessity of care provided. Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate. Coordinates the patient’s care with other health care personnel to ensure timely post-discharge care. Secures outpatient follow-up appointments and scheduling tests or procedures with appropriate providers. Refers to Ambulatory Case Manager patients identified that require oversight of outpatient care and compliance to avoid unnecessary readmissions. Coordinates referrals and secure appointments with various disease management programs. Enters and updates all authorization and clinical information into the system no later than date of discharge. Communicates with Medical Director, Employee Health Services, Risk Management, and the TPA; attends clinical team meetings and reports high-risk/high-cost cases. Advises timely and accurate reporting to the TPL carrier of all injured worker cases receiving case management services. Ensures appropriate utilization of medical services within the workers’ compensation framework and guides patient movement through care levels. Qualifications
Education: Graduation from an accredited school of nursing required Bachelor of Science in Nursing required License/Certifications: Valid CA RN license required Certified Case Management preferred or willing to obtain within 2 years from start date Experience: 2 years in acute care nursing (Medical Surgical/Tele/ICU/LTACH) or 1 year in acute care nursing with 2+ years in care management (UM or DC Planning). 1 year of prior case management experience in inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient, home health and SNF settings preferred Knowledge of workers compensation rules and regulations is highly preferred Knowledge of Epic is highly preferred At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases. For this reason, we require that all new employees receive a flu vaccine as a condition of employment, and annually thereafter as a condition of continued employment. Cedars-Sinai is an EEO employer. Cedars-Sinai does not discriminate on the basis of race, religion, color, national origin, citizenship, ancestry, disability, medical condition, marital status, sex, gender, sexual orientation, gender identity, pregnancy, age, military/veteran status or any other basis protected by law. If you need a reasonable accommodation for any part of the employment process, please email Applicant_Accommodation@cshs.org. Requests for accommodation will be considered on a case-by-case basis. Cedars-Sinai will consider qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring. Req ID : 12508 Working Title : RN Care Coordinator - Inpatient Specialty Program Department : Case Management Business Entity : Cedars-Sinai Medical Center Job Category : Patient Services Job Specialty : RN Overtime Status : NONEXEMPT Primary Shift : Day Shift Duration : 8 hour Base Pay : 55.11 - 88.18
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Join Cedars-Sinai Cedars-Sinai has been named to the Honor Roll for the ninth consecutive year and tied for #1 in California and Los Angeles in U.S. News & World Report’s “Best Hospitals 2024-25” rankings, as well as placed among the very best in 11 specialties nationwide. Align yourself with an organization that has a reputation for excellence. Cedars-Sinai was awarded multiple national recognitions for providing high-quality medical care and for outstanding employee engagement. This role offers the opportunity to contribute to a culture of innovation and care. Why work here? We offer competitive benefits including health and dental insurance, vacation, and a 403(b). Our staff reflects the diverse community we serve and we are committed to a dynamic, inclusive environment that fuels innovation. Responsibilities
Meets with patients within 24 hours of admission and conducts an initial assessment. Collaborates with the designated hospitalist every day during rounds to discuss disposition planning and assess suitability for each patient’s hospital stay. Reviews with the hospitalist the patient’s admission and ongoing stay for medical necessity, appropriateness of care and level of care. Uses Milliman and Interqual guidelines as necessary. Collaborates with clinical teams to synchronize operations and conducts utilization review as appropriate to match the payor. Investigates, processes, and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and policy. Initiates discharge planning and care assessment within one working day (preferably on day of admission). Submits necessary clinical information to the health plan using the accepted format and coordinates health plan communication with the assigned hospitalist. For patients transitioning to Skilled Nursing Facilities, refers to the nurse practitioner and case manager assigned to the SNF for continued review and follow-up. Authorizes services based on covered benefits and necessity of care provided. Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate. Coordinates the patient’s care with other health care personnel to ensure timely post-discharge care. Secures outpatient follow-up appointments and scheduling tests or procedures with appropriate providers. Refers to Ambulatory Case Manager patients identified that require oversight of outpatient care and compliance to avoid unnecessary readmissions. Coordinates referrals and secure appointments with various disease management programs. Enters and updates all authorization and clinical information into the system no later than date of discharge. Communicates with Medical Director, Employee Health Services, Risk Management, and the TPA; attends clinical team meetings and reports high-risk/high-cost cases. Advises timely and accurate reporting to the TPL carrier of all injured worker cases receiving case management services. Ensures appropriate utilization of medical services within the workers’ compensation framework and guides patient movement through care levels. Qualifications
Education: Graduation from an accredited school of nursing required Bachelor of Science in Nursing required License/Certifications: Valid CA RN license required Certified Case Management preferred or willing to obtain within 2 years from start date Experience: 2 years in acute care nursing (Medical Surgical/Tele/ICU/LTACH) or 1 year in acute care nursing with 2+ years in care management (UM or DC Planning). 1 year of prior case management experience in inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient, home health and SNF settings preferred Knowledge of workers compensation rules and regulations is highly preferred Knowledge of Epic is highly preferred At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases. For this reason, we require that all new employees receive a flu vaccine as a condition of employment, and annually thereafter as a condition of continued employment. Cedars-Sinai is an EEO employer. Cedars-Sinai does not discriminate on the basis of race, religion, color, national origin, citizenship, ancestry, disability, medical condition, marital status, sex, gender, sexual orientation, gender identity, pregnancy, age, military/veteran status or any other basis protected by law. If you need a reasonable accommodation for any part of the employment process, please email Applicant_Accommodation@cshs.org. Requests for accommodation will be considered on a case-by-case basis. Cedars-Sinai will consider qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring. Req ID : 12508 Working Title : RN Care Coordinator - Inpatient Specialty Program Department : Case Management Business Entity : Cedars-Sinai Medical Center Job Category : Patient Services Job Specialty : RN Overtime Status : NONEXEMPT Primary Shift : Day Shift Duration : 8 hour Base Pay : 55.11 - 88.18
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