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 payors 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 the hospital bed control system and works 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.
Required Skills
- Excellent verbal and written communication skills
- Thorough 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
Required Experience
Required:
- 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.
- LA City Fire card within 6 months of employment (PHGSH only)
Preferred:
- CCM or ACM (Certified Case Manager, Accredited Case Manager)
- Minimum of one (1) year acute hospital nursing experience with ICU or ED background
- Previous experience in case management.
- Knowledge of payer requirements and previous experience in case management or bed control.
Address
1225 Wilshire Boulevard
Salary
51.54-77.52
Shift
Nights
FLSA Status
Non-Exempt
Shift Differential
4.50
Zip Code
90017
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