Lead Case Manager, RN-Inpatient Specialty Program - Beverly Hills, CA
Lead Case Manager, RN-Inpatient Specialty Program - Beverly Hills, CA
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Job Description
ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans Transitioning Military National Guard and Reserve Members Military Spouses Wounded Warriors and their Caregivers. If you have the required skill set education requirements and experience please click the submit button and follow the next steps. Unless specifically stated otherwise this role is On-Site at the location detailed in the job post.
Cedars-Sinai has been named to the Honor Roll for the ninth consecutive year and tied for #1 in California and Los Angeles in U.S. News & World Reports Best Hospitals 2024-25 rankings as well as placed among the very best in 11 specialties nationwide.
Align yourself with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporations Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded the Advisory Board Companys Workplace of the Year. This recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. Join us! Discover why U.S. News & World Report has named us one of Americas Best Hospitals.
Why work here
Beyond outstanding employee benefits including health and dental insurance vacation and a 403(b) we take pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic inclusive environment that fuels innovation.
A Little More About What You Will be Doing
The Lead Case Manager will assist in the daily operations of the inpatient case management department. Primary responsibility is to provide oversight of the daily functions of the inpatient case managers. The inpatient case manager conducts case management on patients in the inpatient and Skilled Nursing Facility settings. CSMNS has developed a case management program that is geared towards the management of patients while hospitalized and upon discharge from various care settings. Using the Case Management Society of Americas (CMSA) model we describe our approach as a collaborative process of assessment planning facilitation and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality cost-effective collaboration with the Inpatient Specialty Program (ISP) hospitalists (physicians who practice hospital medicine) and the Clinical Integration (C.I.) Community physicians the program is designed to assist patients from the time they are admitted until they are discharged from the hospital by assessing their needs coordinating care communicating with health plans (including concurrent review which assists the hospitalist/specialist and case manager to determine the appropriateness of services rendered and to ensure that quality care is delivered in a cost-effective manner) and referring to disease management programs and ambulatory case management (focus is on those members requiring complex and/or chronic care for follow up after discharge).
Job duties and responsibilities:
Care manager meets with patients within 24 hours of admission and conducts an initial assessment.
Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patients stay.
Submit necessary clinical information to the health plan using the accepted formats (MCG/InterQual and coordinate health plan communication with assigned hospitalist as appropriate.
For patients who are transitioning to the Skilled Nursing Facilities refer to nurse practitioner and case manager assigned to the SNFs for continued review and follow up.
Authorize all appropriate services based upon covered benefits and necessity of care provided.
Coordinate discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate.
Secure outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers.
Referral to Ambulatory Case Manager for those patients identified that will need oversight of outpatient care and compliance to avoid unnecessary readmissions.
Coordinate referrals and secure appointment with various CSMNS disease management programs such as anticoagulation clinic Asthma Diabetes Hepatitis C smoking cessation cardiovascular risk reduction and nutrition as appropriate.
Enter and update all authorization and clinical information into Nautilus (Access Express) no later than date of discharge.
Ambulatory case managers will contact the patients telephonically shortly after discharge or may sometimes meet with them in their respective doctors offices.
Monitor 30-day readmissions
Function as the contact person for clinical issues workflow processes and as a triage/resource to MDN inpatient case management operations.
Manages staffing schedule responds to sick calls and unscheduled absences and adjust staffing accordingly. Assists with training new hires; oversees projects and initiatives as assigned; and conducts documentation audits.
Qualifications
Education:
Graduation from an accredited school of nursing required
Bachelor of Science in Nursing degree preferred
License/Certifications:
Valid CA RN license required
Certified Case Manager certification preferred
Experience:
3 years of acute nursing experience required
3 years of previous experience in case management discharge planning utilization review and HMO in the acute inpatient or outpatient settings preferred
Minimum Salary
49.66
Maximum Salary
79.46
Required Experience:
Manager
Employment Type
Full Time
