Case Manager - RN - Case Management - Full Time 8 Hour ...

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 u2022 Able to effectively manage a case load of 18-20 patients u2022 Utilizes the on line Work list to manage daily assigned caseload. u2022 Assess physical and biopsychosocial needs of the patient through clinical assessment and utilizing data from multiple sources. u2022 Analyze and interpret data in collaboration with patient, family, physician, health care team to develop a plan of care. u2022 Ensures that a physician specific plan of care is in place for all patients. u2022 Actively participates in interdisciplinary meetings. u2022 Initiates a discharge planning assessment within 24 business hours of admission and documents in computer system. u2022 Assesses ongoing discharge planning needs and documents is computer system as changes to the plan occur. u2022 Demonstrates collaborative working relationship with social workers to ensure patient psychosocial needs are met. u2022 Participates in physician and unit rounds. u2022 Completes Medicare One Day Stay forms timely. u2022 Completes disposition form for medicare patients timely. + Consultant u2022 Demonstrates sound clinical knowledge base. u2022 Serves as a consultant to the health care team to identify financial issues that may affect care. u2022 Participates in the education of health care team members on current healthcare issues impacting practice patterns and reimbursement. u2022 Educates physicians and health care team on observation status, as appropriate. + Leadership u2022 Represents the department in a positive and professional manner. u2022 Assists with orientation of new staff. u2022 Delegates and assists with supervision of Case Management Assistants. u2022 Makes appropriate referrals to Physician Advisor, communicating accurate clinical information. u2022 Participates in InterQual competency testing as requested by department director. + Outcomes Management u2022 Participates in core measure process in identification of appropriate patients. u2022 Participates in hospital quality improvement processes and helps identifies opportunities to improve care. u2022 Adheres to TENET policies and procedures. u2022 Identifies compliance and ethical issues and reports appropriately. + Patient Advocacy u2022 Respects patient/family values and beliefs. u2022 Responds promptly to patient/family requests. u2022 Supports patient/family with end of life issues, making appropriate referrals. u2022 Include patient/family in care decisions and discharge planning. + Patient Education u2022 Assist health care team with identification of patient/family educational needs for discharge. u2022 Inform patient/family of discharge plans. u2022 Work with post acute services to address educational needs to ensure a safe discharge plan. + Resource Management u2022 Proposes alternative treatment options to ensure a cost effective and efficient plan of care. u2022 Identifies and creates solutions to remove barriers that may impede optimal patient care. u2022 Identifies and documents avoidable delays in the M drive. u2022 Maintains awareness of current managed care contract requirements. u2022 Participates in appeal process. u2022 Performs and documents InterQual assessments upon admission u2022 Performs and documents InterQual assessments upon a change in level of care u2022 Performs and documents InterQual assessments at least every three days u2022 Performs and documents InterQual assessments upon discharge. u2022 Completes clinical reviews timely and communicates to appropriate payer. u2022 Able to prioritize clinical reviews. u2022 Documents payer communication and authorization in the Authorization log. u2022 Completes and submits TARu2019s for processing within 3 working days of patient discharge. u2022 Notifies director and physician advisor timely of patients who do not meet InterQual criteria. u2022 Other duties as requested or assigned. Required Qualifications: + Req Associateu2019s Degree Nursing + Req 5 years Clinical acute care nursing experience + Req 2 years Case management experience within the past five (5) years. + Req Knowledge of case management principles and healthcare management. + Req Problem solving skills and ability to multi-task. Preferred Qualifications: + Pref Bacheloru2019s Degree Nursing Required Licenses/Certifications: + Req Registered Nurse - RN (CA DCA) + Req Basic Life Support (BLS) Healthcare Provider from American Heart Association + Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only) The hourly rate range for this position is $47.31 u2013 $100.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidateu2019s 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.

Created: 2026-02-06