We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.
The RN Case Manager is responsible for performing a high level 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. Ensures case management documentation in the medical record is clear and complete.Job Responsibilities/Duties
Minimum Education:Graduate from an Accredited Professional School of Nursing required. Bachelor of Science in Nursing preferred.
Minimum Experience:One (1) year of acute hospital case management experience OR successful completion of Alta Nursing to Case Management Training Program required. Computer/EMR Proficiency and Literacy required. Knowledge of CMS, Medicare, Medi-Cal and Managed Care reimbursement required. Familiarity of Joint Commission, CMS, CDPH requirements required. 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. Bilingual skills to communicate effectively with patients and families preferred. Familiarity with AllScripts Care Management preferred. Proficiency with Milliman Care Guidelines or Interqual preferred.
Req. Certification/Licensure:Current Licensure as a Registered Nurse in the State of California required. Certified Case Manager (CCM) preferred.Employee Value Proposition
Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:
To apply for this role, or search our other openings, please visit com/careers/ and click on a location to begin your journey to a new career with us!
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.
EEOC is the Law: eeoc. gov/employers/poster. cfm
Keywords: CM, Case Mgmt, Manager, Management, Utilization Review, RN, Registered Nurse, Clinical9955