ER Case Manager Registered Nurse RN

This position supports the Mission of the Hospital through the provision of distinctive and compassionate care to our patients. This position is responsible for utilization review, assessment of discharge planning needs and coordination of effective discharge plan.

• Current CA Nursing License RN
• Current CPR BLS for healthcare provider’s card upon hire
• Two years previous clinical experience in acute care setting. Minimum one year experience as case manager in acute care setting.
• Demonstrate the knowledge and skills necessary in Case Management with an understanding of severity of illness and intensity service.
• Ability to demonstrate knowledge and skills necessary to provide care appropriate to the age served on the unit. Possess knowledge of growth and development over the life span.
• Must be able to type and use an EMR.
• Must know the Inter Qual process.

• Reviews emergency department and inpatient admissions for medical necessity using Inter Qual criteria, obtains authorizations from health plans, communicates with physicians regarding admission status and denials, and maintains accurate documentation in electronic medical records.
• Responsible for conducting utilization review and case management activities to ensure appropriate level of care, regulatory compliance, and effective discharge planning.
• Obtain and manage payer authorizations and communicate coverage determinations.
• Coordinate comprehensive discharge planning and post-acute care services.
• Identify patients at risk for readmission and facilitate community resource referrals.
• Collaborate with physicians, nursing, social work, and external providers to assess needs and coordinate discharge planning
• Monitor quality-of-care issues and report concerns to Quality Management.
• Educate healthcare staff on case management processes and best practices.
• Support compliance activities, audits, and payer relations

Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for College Medical Center roles, including but not limited to shift differential and other special pay practices, etc. The posted compensation for the position is a reasonable estimate that extends from the lowest to the highest pay that College Medical Center in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.