Bachelor's Degree from an accredited nursing school required
3 years of nursing experience required
1-2 years of case management experience in an outpatient setting required
Current California RN license required
Responsibilities
Meet with patients within 24 hours of admission for initial assessment
Consult daily with assigned hospitalist during morning rounds for disposition planning
Review patient admission and continued stay for medical necessity using Milliman and Interqual guidelines
Plan discharges and conduct care assessments
Submit clinical information to health plans and coordinate communication with hospitalist
Coordinate with nurse practitioners and case managers at SNFs for follow-up
Communicate transition of care details to patients or responsible parties
Authorize services based on covered benefits and necessity across various care settings
Coordinate discharge planning with PCPs, hospitalists, and specialists
Secure outpatient follow-up appointments and schedule tests or procedures
Refer patients needing oversight to Ambulatory Case Manager
Coordinate referrals to disease management programs
Benefits
Collaborative work environment with hospitalists and specialty programs
Opportunity to impact patient care from admission to discharge
Engagement in comprehensive care coordination
Access to established guidelines for medical necessity assessments
Involvement in discharge planning and follow-up care processes
Full Job Description
Job Description
The Case Manager is responsible for the case management of patient while hospitalized and upon discharge from various care settings. In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the Case Manager will assist patients from the time they are admitted until they are discharged from the hospital by assessing their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered and to ensure that quality care is delivered in a cost-effective manner.
Responsibilities
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 patient's stay.
Reviews with hospitalist the patient's 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 SNF's 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) Member's 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.
Coordinate referrals and secure appointment with various CSMNS disease management programs.
Qualifications
Job 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 required
About Cedars-Sinai
Cedars-Sinai is a non-profit academic medical center located in Los Angeles, California. It is one of the largest hospitals in the United States, with over 1,000 beds and 2,000 physicians. Cedars-Sinai is known for its high-quality patient care, cutting-edge research, and innovative medical education programs. The hospital has been ranked as one of the best in the country by U.S. News & World Report, and has received numerous awards and accolades for its clinical excellence and research achievements. Cedars-Sinai is affiliated with the David Geffen School of Medicine at UCLA and is a member of the Cedars-Sinai Health System.
