RN, Case Manager

Title: RN, Case Manager

Location: Laguna Hills

Department: Inpatient/ Specialty Services

Status: Full-time

Shift: Days

Pay Range*: $48.94/hour - $70.96/hour

Bonus: $10,000 sign on

At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.

Position Summary

Under minimal supervision and in a professional manner, the Registered Nurse inpatient case manager performs all job duties to the highest level of customer service and assistance to both internal and external customers of Memorial Care Medical Foundation. This position requires exceptional clinical and communication skills in support of patients, their care givers and providers when seen at or admitted to the acute care setting. The nurse case manager is required to meet all elements as required by hospital governing bodies as well as managed care delegation requirement for this position to ensure appropriate admissions, ongoing concurrent treatment, discharge planning and transitions of care for the populations served. The position is critical to the organization's inpatient utilization and quality outcomes for populations we manage.

Essential Functions and Responsibilities of the Job

• On-site, clinical reviews, admission and concurrent, for GNP patients in identified settings

• Document appropriately and per hospital DNV and CMS regulatory requirements within aligned electronic UM/CM system

• Provide discharge planning and transitions of care per assignment and in accordance with DNV, Health Plan and DOFR

• Support after hours and weekend case management activities based on business needs and per standard workflows and policies as assigned

• Be at work and be on time

• Follow company policies, procedures and directives

• Interact in a professional, positive and constructive manner

• Prioritize and multitask

• Be at work and be on time

• Follow company policies, procedures and directives

• Interact in a positive and constructive manner

• Prioritize and multitask

• 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 this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there's more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Experience

• 3 years clinical experience Inpatient nursing or related field

• 1 year previous inpatient Case Management experience. 1 year or greater.

• Previous and or ability to learn use of electronic medical record, UM/CM platforms or electronic health record preferred.

• Knowledge of CMS (Centers for Medicare and Medicaid Services) coverage policies required.

• Work experience in Microsoft Word, Microsoft Excel and Microsoft Outlook.

• Work experience applying evidence-based criteria (i.e.: MCG, lnterqual); Health plan medical policy / clinical coverage guidelines.

Education

• Current California RN License required

• Associate degree (AA) in nursing, required

• Bachelor of Science in Nursing, preferred

• CCM preferred.

• Basic Life Support (BLS)