Case Manager

Case Manager RN or LVN - Ambulatory Case Management

Are you ready to bring your clinical competencies to a world-class Medical Group known for the very highest clinical standards? Do you have a passion for the highest quality and patient satisfaction? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! The Cedars-Sinai Medical Network is committed to helping primary care and specialist physicians provide excellent care to all their patients who benefit from convenient access to primary and specialty care physicians and seamless coordination of care between them. As a part of Cedars-Sinai our physicians and staff are partners in quality health care from a medical center that is consistently recognized as one of the finest hospitals in the country.

For the 8th consecutive year we have been named one of the top 20 Physician Groups in Southern California by Integrated Healthcare Associates (IHA). Beyond outstanding benefits competitive salaries and health and dental insurance we take pride in hiring the best most passionate employees. Our talented staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic inclusive environment that fuels innovation and the gold standard of patient care we strive for.

Primary Duties and Responsibilities

Meets with patients within 24 hours of admission and conducts an initial assessment. Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patients stay. Reviews with hospitalist the patients admission and continued stay for medical necessity appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary. Plans for discharges and care assessments. Submits necessary clinical information to the health plan using the accepted format (MIDAS or telephonic) and coordinate health plan communication with assigned hospitalist as appropriate. Coordinates with nurse practitioner and case manager assigned to the SNFs for continued review and follow up. Communicates transition of care to the member or responsible party including: i) Transition process and what to expect ii) Changes in health status and the care plan iii) Staff who will be handling issues questions concerns i.e. Case Manager. Authorizes all appropriate services based upon covered benefits and necessity of care provided in the: a) Members home or residence b) Acute Care c) Skilled Nursing Facility d) Rehabilitation Facility e) Home Health Care f) Custodial Care facility or Board and Care Facility. Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate. Secures outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers. Refers to Ambulatory Case Manager for those patients identified that need oversight of outpatient care and compliance to avoid unnecessary readmissions. Coordinates referrals and secure appointment with various CSMNS disease management programs.

Qualifications

Education: Bachelor's Degree Graduate of an accredited school of nursing required Work Experience: 3 years nursing experience required 1 year 1-2 years of previous experience in case management in the outpatient setting required Licenses and Certifications: State License current California RN or LVN licensure required Certified Case Management RN or LVN preferred