Registered Nurse - Inpatient Care Coordinator - Per Diem - 8 Hour Days

Job Description 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 Report’s “Best Hospitals 2024‑25” rankings, as well as placed among the very best in 11 specialties nationwide. Join us to be part of a leading organization that prioritizes excellence, research, and employee engagement. Why work here? Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b), we pride ourselves on building a diverse, inclusive environment that fuels innovation. What You Will Be Doing The Case Manager is responsible for the case management of patients while hospitalized and upon discharge from various care settings. In collaboration with Inpatient Specialty Program (ISP) hospitalists, the Case Manager will assist patients from admission until discharge by assessing needs, coordinating care, and communicating with health plans and providers. Job duties and responsibilities Meet with patients within 24 hours of admission and conduct an initial assessment. Consult with assigned hospitalist each morning regarding disposition planning and appropriateness for each day of the patient’s stay. Review admission and continued stay for medical necessity and appropriateness of care; use Milliman and Interqual guidelines as necessary. Collaborate with clinical teams and practices to synchronize sub‑areas’ operations to reach organizational and departmental goals. Investigate, process, and assist with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. Begin discharge planning and care assessment within one working day, preferably on the day of admission. Submit necessary clinical information to the health plan using accepted formats (MIDAS or telephonic) and coordinate communication with the assigned hospitalist. For patients transitioning to Skilled Nursing Facilities, refer to the nurse practitioner and case manager assigned to that SNF. Authorize all appropriate services based upon covered benefits and necessity of care. Coordinate discharge planning and alternative treatment plans with PCP, hospitalist, or specialist as appropriate. Coordinate the patient’s care with other health care personnel to ensure timely post‑discharge care. Secure outpatient follow‑up appointments and schedule tests or procedures with appropriate providers. Refer ambulatory case manager patients who need oversight of outpatient care to avoid unnecessary readmissions. Coordinate referrals and secure appointments with various CSMNS disease‑management programs. Enter and update all authorization and clinical information into Nautilus (Access Express) no later than discharge date. Communicate regularly with CSMPN Medical Director, Employee Health Services, Risk Management, and TPA. Attend all CSMPN clinical team meetings and report high‑risk/high‑cost cases. Direct timely and accurate reporting to the TPL carrier for all injured worker cases receiving case‑management services. Ensure appropriate utilization of medical services within the parameters of workers‑compensation benefits or utilization decisions, facilitating movement through levels of care. Qualifications Graduation from an accredited school of nursing. Bachelor of Science degree in Nursing. License/Certifications Valid CA RN license. Certified Case Management preferred or willingness to obtain within 2 years. Current BLS certification from ARC or AHA. Experience 2 years in acute care nursing (Medical‑Surgical/Tele/ICU/LTACH) or 1 year in acute care nursing with 2+ years of care‑management experience. 1 year of previous case‑management experience in acute inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient, home health, and SNF settings preferred. Knowledge of workers‑compensation rules and regulations highly preferred. Knowledge of Epic highly preferred. Cedars‑Sinai is an EEO employer. We do not discriminate on any protected basis. If you need a reasonable accommodation for any part of the employment process, please contact us by email at View email address on click.appcast.io. We consider qualified applicants with criminal histories in accordance with the Los Angeles Fair Chance Initiative for Hiring. All new employees are required to receive a flu vaccine based on seasonal availability as a condition of employment and annually thereafter. #J-18808-Ljbffr Cedars-Sinai