University of Southern California
RN Case Manager - Case Management - Per Diem 8 Hour Days (Non-Exempt) (Union)
University of Southern California, Glendale, California, us, 91222
RN Case Manager - Case Management - Per Diem 8 Hour Days (Non-Exempt) (Union)
Keck Medicine of USC – Hospital – Los Angeles, California
In collaboration with the interdisciplinary team, provides care coordination services evaluating options and services required to meet an individual's health care needs to promote cost‑effective, quality outcomes. Serves as a consultant to members of the health care team in the management of specific patient populations. The RN case manager role integrates the functions of utilization management, quality management, discharge planning assessment, and coordination of post‑hospital care services, including transfers to an alternative level of care.
Essential Duties
Clinical Care Coordination
Able to effectively manage a case load of 18-20 patients
Utilizes the online Work list to manage daily assigned caseload
Assess physical and biopsychosocial needs of the patient through clinical assessment and utilizing data from multiple sources
Analyze and interpret data in collaboration with patient, family, physician, health care team to develop a plan of care
Ensures that a physician‑specific plan of care is in place for all patients
Actively participates in interdisciplinary meetings
Initiates a discharge planning assessment within 24 business hours of admission and documents in computer system
Assesses ongoing discharge planning needs and documents in computer system as changes to the plan occur
Demonstrates collaborative working relationship with social workers to ensure patient psychosocial needs are met
Participates in physician and unit rounds
Completes Medicare One Day Stay forms timely
Completes disposition form for Medicare patients timely
Consultant
Demonstrates sound clinical knowledge base
Serves as a consultant to the health care team to identify financial issues that may affect care
Participates in the education of health care team members on current healthcare issues impacting practice patterns and reimbursement
Educates physicians and health care team on observation status, as appropriate
Leadership
Represents the department in a positive and professional manner
Assists with orientation of new staff
Delegates and assists with supervision of Case Management Assistants
Makes appropriate referrals to Physician Advisor, communicating accurate clinical information
Participates in InterQual competency testing as requested by department director
Outcomes Management
Participates in core measure process in identification of appropriate patients
Participates in hospital quality improvement processes and helps identify opportunities to improve care
Adheres to TENET policies and procedures
Identifies compliance and ethical issues and reports appropriately
Patient Advocacy
Respects patient/family values and beliefs
Responds promptly to patient/family requests
Supports patient/family with end‑of‑life issues, making appropriate referrals
Includes patient/family in care decisions and discharge planning
Patient Education
Assists health care team with identification of patient/family educational needs for discharge
Informs patient/family of discharge plans
Works with post‑acute services to address educational needs to ensure a safe discharge plan
Resource Management
Proposes alternative treatment options to ensure a cost‑effective and efficient plan of care
Identifies and creates solutions to remove barriers that may impede optimal patient care
Identifies and documents avoidable delays in the M drive
Maintains awareness of current managed‑care contract requirements
Participates in appeal process
Performs and documents InterQual assessments upon admission
Performs and documents InterQual assessments upon a change in level of care
Performs and documents InterQual assessments at least every three days
Performs and documents InterQual assessments upon discharge
Completes clinical reviews timely and communicates to appropriate payer
Able to prioritize clinical reviews
Documents payer communication and authorization in the Authorization log
Completes and submits TARs for processing within 3 working days of patient discharge
Notifies director and physician advisor timely of patients who do not meet InterQual criteria
Other duties as requested or assigned
Required Qualifications
Associate's Degree Nursing
3 years clinical experience
Knowledge of case‑management principles and healthcare management
Problem‑solving skills and ability to multi‑task
Preferred Qualifications
Bachelor's Degree Nursing
Required Licenses/Certifications
Registered Nurse – RN (CA DCA)
Basic Life Support (BLS) – Healthcare Provider from American Heart Association
Fire Life Safety Training – LA City (must be obtained within 30 days of hire and renewed before expiration date for LA City only)
The hourly rate range for this position is $47.31 – $100.00. When extending an offer of employment, the University of Southern California considers factors such as the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
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In collaboration with the interdisciplinary team, provides care coordination services evaluating options and services required to meet an individual's health care needs to promote cost‑effective, quality outcomes. Serves as a consultant to members of the health care team in the management of specific patient populations. The RN case manager role integrates the functions of utilization management, quality management, discharge planning assessment, and coordination of post‑hospital care services, including transfers to an alternative level of care.
Essential Duties
Clinical Care Coordination
Able to effectively manage a case load of 18-20 patients
Utilizes the online Work list to manage daily assigned caseload
Assess physical and biopsychosocial needs of the patient through clinical assessment and utilizing data from multiple sources
Analyze and interpret data in collaboration with patient, family, physician, health care team to develop a plan of care
Ensures that a physician‑specific plan of care is in place for all patients
Actively participates in interdisciplinary meetings
Initiates a discharge planning assessment within 24 business hours of admission and documents in computer system
Assesses ongoing discharge planning needs and documents in computer system as changes to the plan occur
Demonstrates collaborative working relationship with social workers to ensure patient psychosocial needs are met
Participates in physician and unit rounds
Completes Medicare One Day Stay forms timely
Completes disposition form for Medicare patients timely
Consultant
Demonstrates sound clinical knowledge base
Serves as a consultant to the health care team to identify financial issues that may affect care
Participates in the education of health care team members on current healthcare issues impacting practice patterns and reimbursement
Educates physicians and health care team on observation status, as appropriate
Leadership
Represents the department in a positive and professional manner
Assists with orientation of new staff
Delegates and assists with supervision of Case Management Assistants
Makes appropriate referrals to Physician Advisor, communicating accurate clinical information
Participates in InterQual competency testing as requested by department director
Outcomes Management
Participates in core measure process in identification of appropriate patients
Participates in hospital quality improvement processes and helps identify opportunities to improve care
Adheres to TENET policies and procedures
Identifies compliance and ethical issues and reports appropriately
Patient Advocacy
Respects patient/family values and beliefs
Responds promptly to patient/family requests
Supports patient/family with end‑of‑life issues, making appropriate referrals
Includes patient/family in care decisions and discharge planning
Patient Education
Assists health care team with identification of patient/family educational needs for discharge
Informs patient/family of discharge plans
Works with post‑acute services to address educational needs to ensure a safe discharge plan
Resource Management
Proposes alternative treatment options to ensure a cost‑effective and efficient plan of care
Identifies and creates solutions to remove barriers that may impede optimal patient care
Identifies and documents avoidable delays in the M drive
Maintains awareness of current managed‑care contract requirements
Participates in appeal process
Performs and documents InterQual assessments upon admission
Performs and documents InterQual assessments upon a change in level of care
Performs and documents InterQual assessments at least every three days
Performs and documents InterQual assessments upon discharge
Completes clinical reviews timely and communicates to appropriate payer
Able to prioritize clinical reviews
Documents payer communication and authorization in the Authorization log
Completes and submits TARs for processing within 3 working days of patient discharge
Notifies director and physician advisor timely of patients who do not meet InterQual criteria
Other duties as requested or assigned
Required Qualifications
Associate's Degree Nursing
3 years clinical experience
Knowledge of case‑management principles and healthcare management
Problem‑solving skills and ability to multi‑task
Preferred Qualifications
Bachelor's Degree Nursing
Required Licenses/Certifications
Registered Nurse – RN (CA DCA)
Basic Life Support (BLS) – Healthcare Provider from American Heart Association
Fire Life Safety Training – LA City (must be obtained within 30 days of hire and renewed before expiration date for LA City only)
The hourly rate range for this position is $47.31 – $100.00. When extending an offer of employment, the University of Southern California considers factors such as the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
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