Hospital Registered Nurse Case Manager

HealthCare Support Staffing, Inc. (HSS), is a proven industry‑leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non‑clinical positions with some of the largest and most prestigious healthcare facilities including Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long‑lasting and rewarding career! Job Description Performs daily pre‑admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved at the local level to the next level immediately. Monitors the progression of the plan of care and facilitates discussions with the multidisciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives. Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care). Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies. Performance Improvement: Monitors care processes to provide cost‑effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols. Participates in the development and implementation of guidelines, pre‑printed physician orders, care paths, etc. for patient care. Identifies and assists in the implementation of opportunities for cost‑savings and improvements in the quality of care across the continuum. Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one‑day stays, DRGs, LOS, etc. Participates in the development, implementation, communication, maintenance and monitoring of local UM Workplan initiatives. Administrative and Regulatory: Shares accountability with the UM Manager for planning, developing, and managing the department budget. Participates in interviewing, makes hiring recommendations, orients and provides on‑going supervision of support staff. Provides input into the performance evaluations of team members. May plan and control work assignments and special projects of team members. Assists in developing, implementing and maintaining utilization management policies and procedures. Qualifications Must have clear and active RN license in CA. BSN or equivalent education/experience in nursing or health related field. Acute care case management required within a hospital setting (minimum 1 year within the last 3 years) with references to reflect. Previous case management experience and demonstrated experience in utilization management, discharge planning, or transfer coordination. Knowledge of Nurse Practice Act, The Joint Commission and other federal/state/local regulations. Additional Information Hours for this Position: 2 nurses needed to work 8‑4:30pm and requires every other weekend and holiday shifts. 1 nurse needed to work 2pm‑10:30pm in the Emergency Department; may also include day/swing/evening shifts and every other weekend is required. #J-18808-Ljbffr Healthcare Support Staffing