Registered Nurse Case Manager

RN Case Manager – Pre-Access (Per Diem)Valley Presbyterian HospitalEnsure the Right Care, at the Right Time, in the Right SettingAt Valley Presbyterian Hospital, our Case Management team plays a critical role in supporting patient access, regulatory compliance, and efficient care delivery. We are seeking an experienced RN Case Manager – Pre-Access to coordinate admission reviews, facilitate patient transfers, and ensure appropriate patient status determinations based on medical necessity guidelines. This role serves as a key liaison between physicians, nursing, admitting, financial services, and external healthcare organizations to support seamless patient access and optimal utilization of hospital resources.What You'll DoReview all acute care admissions to ensure appropriate patient status and level of care using established medical necessity criteriaConduct admission reviews utilizing InterQual and other proprietary utilization review toolsDocument admission determinations within the electronic medical record and utilization management systemsCollaborate with admitting physicians, Emergency Department providers, and hospital leadership to determine the most appropriate level of careCoordinate patient transfers into the hospital, including obtaining clinical information and transfer agreementsServe as a liaison between physician offices, admitting, nursing, business office, and ancillary departments to facilitate efficient admissionsInitiate physician advisor referrals when admission status or level-of-care determinations require additional reviewMonitor observation patients and ensure appropriate status changes and documentationCollaborate with Emergency Department leadership to improve patient throughput and bed utilizationPartner with Operations Supervisors regarding bed placement, patient flow, and special admission needsCommunicate payer requirements, utilization concerns, and reimbursement-related issues to physicians and care teamsParticipate in departmental meetings, bed board huddles, and performance improvement initiativesWhat You BringStrong clinical assessment and critical thinking skillsExpertise in utilization review, admission status determination, and medical necessity criteriaKnowledge of InterQual, CERME, Medicare, Medi-Cal, managed care, and third-party payer requirementsUnderstanding of EMTALA and other federal and state healthcare regulationsAbility to exercise independent judgment and make sound clinical decisionsExcellent communication and relationship-building skillsStrong organizational skills with the ability to manage multiple priorities in a fast-paced environmentAbility to work collaboratively with physicians, nursing, case management, and operational teamsExperienceMinimum two (2) years of direct acute care nursing experience requiredCritical Care experience preferredPrevious Case Management, Utilization Management, or Discharge Planning experience preferredEducationBachelor of Science in Nursing (BSN) requiredRequirementsCurrent California Registered Nurse (RN) licenseManagement of Assaultive Behavior (CPI or equivalent) certification within 30 days of hireLA City Fire Card certification within 30 days of hireWhy VPHMission-driven healthcare organization dedicated to exceptional patient careOpportunity to impact patient access, quality, and resource utilizationCollaborative interdisciplinary environmentDynamic role supporting hospital-wide patient flow and admission operationsProfessional growth opportunities within Case Management and Care CoordinationApply today and help ensure patients receive the appropriate care at the appropriate level while supporting operational excellence at Valley Presbyterian Hospital.Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.