Qualifications

• Bachelor of Science degree in Nursing from an accredited program.
• Valid CA RN license is required.
• Certified Case Management preferred or willingness to obtain within 2 years.
• Current BLS certification from ARC or AHA required.
• 2 years of experience in acute care nursing (Medical Surgical/Tele/ICU/LTACH) or 1 year with additional care management experience.
• Preferred knowledge of HMO and Medicare rules pertaining to various healthcare settings.
• Familiarity with workers compensation regulations is highly preferred.

Responsibilities

• Conduct initial patient assessments within 24 hours of admission.
• Consult daily with hospitalists about patient disposition and stay appropriateness.
• Review patient's admission and continued need for care, utilizing Milliman and Interqual guidelines.
• Collaborate with clinical teams for operational synchronization towards goals.
• Process and resolve provider grievances and appeals as per policies.
• Begin discharge planning as early as one working day post-admission, preferably on day of admission.
• Authorize necessary medical services based on coverage and necessity.

Benefits

• Opportunity to work within a collaborative, interdisciplinary team environment.
• Engagement in patient-centered care, enhancing patient outcomes through effective management.
• Professional development opportunities, including support for certification in case management.
• Access to comprehensive health plans and wellness programs for staff.