Company Info

Martin Luther King, Jr. Community Hospital

1680 East 120th Street
Los Angeles, CA, United States

Phone:
Web Site: mlkch.org

Company Profile


RN Case Manager


col-narrow-left   

Category:

Case Manager

Title:

RN Case Manager

Location:

Los Angeles, CA, United States 

Zip Code:

90059
col-narrow-right   

Employment Type:

Full time
col-wide   

Job Requirements:

POSITION REQUIREMENTS

  • Bachelor of Science degree in nursing preferred
  • Associates in nursing required
  • Minimum of one (1) to three (3) years of hospital acute care inpatient RN experience required.
  • Able to navigate and connect successfully with outside provider networks (Health Plans, IPA’s, and FQHC’s).
  • Current CA Nursing license
  • Certification in Case Management preferred
  • Bilingual language skills preferred (Spanish)
  • Basic computer skills
  • Current Basic Life Support (BLS)

Job Description:

About:

RN Case Managers support the physician and interdisciplinary team to facilitate patient care, to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates the functions of utilization management, care progression and care transition

POSITION REQUIREMENTS

  • Bachelor of Science degree in nursing preferred
  • Associates in nursing required
  • Minimum of one (1) to three (3) years of hospital acute care inpatient RN experience required.
  • Able to navigate and connect successfully with outside provider networks (Health Plans, IPA’s, and FQHC’s).
  • Current CA Nursing license
  • Certification in Case Management preferred
  • Bilingual language skills preferred (Spanish)
  • Basic computer skills
  • Current Basic Life Support (BLS)

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement
  • Facilitation of precertification and payor authorization processes
  • Application of process improvement methodologies in evaluating outcomes of care
  • Coordinating communication with physicians.

Assessment:

  • Completes a comprehensive assessment to identify opportunities for intervention that are appropriate and realistic for the patient/family’s psycho-social, cultural, spiritual, and physical plan of care.
  • Assess the patient’s healthcare needs and goals; specifically targeting the physical, functional, psychosocial, environmental and financial status.
  • Completes and documents timely clinical reviews based on an assessment of medical necessity and documented clinical findings in accordance with Hospital policy and payer requirements.
  • Communicates with attending physician regarding the appropriateness of patient admissions, resource utilization, and when documentation does not support continued stay.
  • Assesses readmission risk based on established Hospital criteria.

Planning:

  • Demonstrates an understanding of medical necessity and intensity of service, and incorporates payer requirements into the development of a safe, effective, and timely discharge plan.
  • Demonstrates an understanding of the patient’s clinical condition, social, and financial resources to determine the most appropriate care setting, practice standards for evaluation, treatment delivery options (Home, SAR, SNF, LTACH, Acute Rehabilitation, Assisted Living, Board/Care, Recuperative Care, Shelter), and resources required to support safe transition of care.
  • Incorporates risk of readmission and socio-economic factors in the creation of a safe and individualized transition plan.
  • Engages the patient and family/support network in developing the transition plan.
  • Collaborates actively with the interdisciplinary team throughout the patient’s stay to re-assess and adjust the plan for care progression and transition according to the patient’s clinical condition.
  • Advocates for the patient with the payer and/or IPA to ensure the most effective care progression and transition plan for the patient.

Implementation:

  • Coordinates the progression of care to ensure that the ongoing needs of the patient and family are adequately addressed.
  • Identifies psychosocial and financial barriers, (e.g. substance abuse, homelessness, unsafe or abusive living arrangement) and collaborates with or delegates to Clinical Social Work colleagues.
  • Identifies discharge planning needs and facilitates transfers to acute and post-acute venues.
  • Demonstrates working knowledge of the clinical requirements, individual payer networks and coverage, and impact of patient’s living environment and support network in creating a transition plan.
  • Identifies and facilitates home care and durable medical equipment needs at the time of discharge.
  • Facilitates palliative or hospice care when needed
  • Oversees discharge planning and facilitates safe transitions to community settings. Proactively identifies and resolves delays and obstacles to discharge.
  • Coordinates and monitors scheduling of tests/procedures of patients and reports results to other healthcare members when appropriate. Identifies recurrent problems and recommends strategies for resolution.

Evaluation

  • Develops and evaluates case management plans and protocols in collaboration with the interdisciplinary team.
  • Evaluates actions taken to assure cost-effective care including physician length of stay, diagnostic related groups cost reporting, morbidity and mortality reports and monitoring of readmissions.
  • Utilizes avoidable day reporting tool to identify sources of barriers to patients’ progression of care.

Communication/Collaboration:

  • Serves as a liaison between members of the interdisciplinary care team, community providers, payers, and patient/family to ensure safe and effective plans and smooth transitions between internal and external levels of care.
  • Ensures consistent and timely communication with Patient Financial Services and HIM as needed to confirm patient status and/or authorization to support the billing process.
  • Collaborates with attending physicians and consultants to review and discuss patient care, progress and identified outcomes. Defines and manages deviations from the plan of care.
  • Participates in and or facilitates patient care conferences and family meetings.
  • Assures prompt reporting of medical/legal issues to Risk Management and appropriate Administrative parties.
  • Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.

Job ID:

36291