PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital
Whittier, PIH Health Hospital
Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women's health, urgent care and emergency services.
The organization is recognized by Watson Health as one of the nation's Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation's top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
The RN Access Case Manager provides care coordination which emphasizes positive partnerships with nursing, physicians and other key disciplines in order to coordinate admissions, transfers and repatriation to PHDH through the emergency room or direct admission. The RN Access Case Manager works closely with insurance and various payor to coordinate and assist with reparation/transfer of out-of-network patients from PHWH to the patient's contracted facilities. The RN Access Case Manager performs utilization review with a high level of expertise by using criteria that demonstrates medical necessity to achieve authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, Outpatient). RN Access Case Manager also provides oversight of hospital bed control system and work in collaboration with House Supervisor to ensure appropriate placement of patients to the right level of care. The RN Access Case Manager works to ensure appropriate utilization of hospital resources in all settings and levels of care.
Excellent verbal and written communication skills
Ability to follow chain of command
Knowledge of hospital operations especially from an ER, ICU, nursing unit, environmental services and financial perspective.
Highly developed ability to multi-task and maintain focus
Proactive, can-do approach and desire to build positive working relationships through collaborative problem-solving
Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility and prioritization skills.
Strong organizational skills
Basic computer skills; Outlook, Word and Excel
Maintain an active California RN License.
Obtain ACM (Accredited Case Manager) or CCM (Certified Case Manager) within 3 years of hire.
Minimum of five (5) years of acute hospital nursing experience
CCM or ACM (Certified Case Manager, Accredited Case Manager)
Minimum of one (1) year acute hospital nursing experience in Critical Care or Emergency Department
Previous experience in case management.
Knowledge of payer requirements and previous experience in case management or bed control.
Beyond the benefits that come with working for the area's leading community healthcare provider - one that also recognizes the need to ensure patient safety and comfort - you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V