What are the responsibilities and job description for the ED Access Case Manager, Care Management, Per diem, 7pm-7:30am position at PIH Health Careers?
The RN Access Case Manager plays a pivotal role in coordinating patient care, fostering collaborative partnerships with nursing, physicians, and other key disciplines. This involves ensuring seamless admissions, transfers, and repatriation to PHDH through the emergency room or direct admission.
Key responsibilities include working closely with insurance providers and various payors to coordinate reparation/transfer of out-of-network patients from PHWH to their contracted facilities. Additionally, the RN Access Case Manager performs thorough utilization reviews, utilizing criteria that demonstrate medical necessity to achieve authorization and reimbursement for services at the appropriate level of care (Inpatient, Observation, Outpatient).
Job Overview
The RN Access Case Manager works in collaboration with House Supervisor to ensure optimal placement of patients in the right level of care. This position also entails providing oversight of hospital bed control systems to guarantee efficient utilization of hospital resources across all settings and levels of care.
Organization Background
{company} is a nonprofit, regional healthcare network serving approximately 3 million residents in the Los Angeles County, Orange County, and San Gabriel Valley region.
The fully integrated network comprises {company} Downey Hospital, {company} Good Samaritan Hospital, {company} Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical group, home healthcare services, and hospice care, as well as heart, cancer, digestive health, orthopedics, women's health, urgent care, and emergency services.
Required Skills
- Excellent verbal and written communication skills
- Thorough knowledge of hospital operations, particularly from an ER, ICU, nursing unit, environmental services, and financial perspective
- Highly developed ability to multitask and maintain focus
- Proactive, can-do approach and desire to build positive working relationships through collaborative problem-solving
- Self-motivated and results-oriented, with sound decision-making, flexibility, and prioritization skills
- Strong organizational skills
- Basic computer skills; Outlook, Word, and Excel
Required Experience
Required:
- Maintain an active California RN License
- Obtain ACM (Accredited Case Manager) or CCM (Certified Case Manager) within 3 years of hire
- Minimum of five (5) years of acute hospital nursing experience
- LA City Fire card within 6 months of employment ({company} only)
Preferred:
- CCM or ACM (Certified Case Manager, Accredited Case Manager)
- Minimum of one (4) year acute hospital nursing experience with ICU or ED background
- Previous experience in case management
- Knowledge of payer requirements and previous experience in case management or bed control
