The Case Manager integrates, coordinates, and advocates for patients to ensure efficient resource utilization and positive health outcomes. Responsibilities include assessing patients for appropriate levels of care, facilitating discharge planning, and communicating with physicians and insurance agencies.
Requirements summary
Candidates must be graduates of an accredited RN program with at least two years of acute care nursing experience. Required certifications include an AHA BLS card and a Los Angeles County Fire Card.
professional certificateCommunicationDocumentationDischarge planningAcute care nursingPatient advocacyBLS certificationPatient assessmentCase managementClinical consultationUtilization reviewMultidisciplinary care coordinationInsurance criteria knowledge
Job description
CHA Hollywood Presbyterian (CHA HPMC) is a nationally recognized acute care facility that has been caring for the Hollywood community and Los Angeles Areas since 1924.
Join our Global Network and be a CHA Global Ambassador
CHA HPMC is also a part of the world-renown CHA Health System (CHS). CHS has CHA University which consists of 14 education institutions including medical school, nursing school and pharmacy. CHA global network operates 81 hospitals and specialty clinics, 30 research and 31 bio/pharmaceutical/healthcare companies with 14,000 employees in seven countries.
Our New Facility is seeking for Top Talents
The best women’s hospital in Los Angeles is looking for current RN candidates to staff Operating Room, Emergency Department, Labor & Delivery and Mother-Baby care units to be housed in our expanding new patient tower facility scheduled to open next year. Come be a part of this dedicated and caring team right in the heart of Hollywood.
Postion Summary
The fundamental focus of the case manager is to integrate, coordinate, and advocate for individuals, families, and groups requiring extensive services to achieve desirable patient outcomes, efficient utilization of resources, patient satisfaction and involvement, and appropriate lengths of stay.
Assessing all patients based on appropriate criteria (severity of illness/intensity of service) for acute care and admission in appropriate setting (ICU, Med/Surg, OB, Peds, Rehab)
Interviewing the patients or significant others to identify post hospital care needs within a timely manner and arrange ancillary service needs identified (HHC, HME, Hospice, transport, etc).
Coordinating patient transfers between facilities.
Assessing the patient for appropriate level of care using the Severity of Illness/Intensity of service criteria.
Referring appropriately to allied health personnel and community resources.
Providing clinical consultation on difficult cases or initiates multidisciplinary care consultations as needed relating to acute care or alternative levels of care.
Exhibiting open communication with physicians and Physician Advisors to facilitate discharge plans and provide the highest quality of care using established criteria.
Serving as a resource for physicians, hospital staff, and outside agencies in reference to insurance criteria and governmental regulation.
Delivering letters of denial, re-determination, and/or referrals to patients, MDs, and billing office upon notification.
Assisting nursing in communicating to Health Department regarding TB screening for authorized discharges.
During interview process may need to assist patient (turn, lift up, etc.).
Maintaining confidentiality of departmental and patient’s information.
Demonstrating knowledge of age specific care, including but not limited to, identifying the need for additional safety measures, physiological normal values/readings; and assessing skin integrity, behavior, motor skills and/or activities that place patients at risk as well as communicates effectively in a clear, concise, understandable manner. Applicable for all populations, infant, pediatric, adult, geriatric.
Pulling files for TARs requested by Physicians required for billing.
Appealing errors discovered in authorization process relative to payer's criteria and process.
Minimum Education
• Graduate of an accredited RN Program
Preferred Education
• Completion of Case Management Course Preferred
Minimum Work Experience and Qualifications
Minimum two years’ experience as a RN in an acute care setting.
Ability to communicate effectively verbally and in writing.
Must be able to work in a union environment.
Preferred Work Experience and Qualifications
• Minimum two years as a Case Manager Preferred.
Required Licensure, Certification, Registration or Designation
AHA BLS Card
Current Los Angeles County Fire Card required (within 30 days of employment).
