RN Case Manager - Value Based Service Organization - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Case Manager

In collaboration with the interdisciplinary team, the Case Manager provides care coordination services evaluating options and services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care team in the management of specific patient populations. The role integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of post-hospital care services, including transfers to an alternative level of care. As more complex medical treatment options emerge the Case Manager will look to eliminate gaps in the care provided, as well as needlessly duplicated treatment, all while controlling the cost of quality patient care. The Case Manager will leverage their clinical and social work experience to ring an understanding of the clinical process of assessment, planning, implementation, and evaluation to the process of case management.

Some of the major duties of a Case Manager include: Documenting patients' case management plans and on-going activities; Identifying patients 'insurance coverage or other sources of payment for services; Identifying and addressing patient risk factors and/or obstacles to care; Identifying patient needs, current services, and available resources, then connecting the patient to services and resources to meet established goals; Communicating the care preferences of patients, serving as their advocate, and verifying that interventions meet the patient's needs and treatment goals; Screening patients and/or population for healthcare needs; Developing a patient-focused case management plan; and Educating the patient/family/caregiver about the case management process and evaluating their understanding of the process.

Some of the major duties of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate patient status is assigned upon admission and prior to discharge; InterQual or MCG reviews are completed within 24 hours of admission; Observation patients are effectively care managed on a daily basis; and Facilitate throughput and timely discharges throughout inpatient level of care.

Essential Duties:

• Clinical Care Coordination
• Consultant
• Leadership
• Outcomes Management
• Patient Advocacy
• Patient Education
• Resource Management

Required Qualifications:

• Req Associate's Degree Nursing
• Req 5 years Clinical experience
• Req 2 years Ambulatory case management or utilization review experience within the last three years
• Req Ability to work independently with minimal supervision, exercising judgment and initiative.
• Req Ability to manage multiple tasks with effective prioritization.
• Req Process oriented.
• Req Good computer skills.

Preferred Qualifications:

• Pref Bachelor's Degree Nursing
• Pref Knowledge of CM standards, UM standards, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, and Medicaid/Medicare contracts and benefit systems.
• Pref 2 years Experience in an HMO/IPA/Managed care setting

Required Licenses/Certifications:

• Req Registered Nurse - RN (CA DCA)
• Req Basic Life Support (BLS) Healthcare Provider from American Heart Association
• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The hourly rate range for this position is $53.00 - $87.45. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at View phone number on click.appcast.io, or by email at View email address on click.appcast.io. Inquiries will be treated as confidential to the extent permitted by law.