RN Case Manager - Utilization Care Management Office
Job Number: 268302
Job Category: Case Management
Providence is calling a Case Manager (RN) - Utilization Care Management Office (Full time/Day shift) at Providence Little Company of Mary Medical Center Torrance in Torrance, CA.
We are seeking a Case Manager (RN) - Utilization Care Management Office who will perform the primary functions of assessment, planning, facilitation and advocacy, which are achieved through collaboration with the client and other health care professionals involved in the client's care.
"Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality cost effective outcomes."
In this position you will:
- Key activities:
- Establish priorities
- Consider evidenced-based protocols for new patients
- Keep running problem sheet on the patient, so hand-offs are easy
- Diagnostics to be reviewed or ordered
- Interactions with sub-specialists
- Consult requests
- Post-acute options and confirmation of targeted transition
- Accuracy and completeness of medical documentation
- Start the discharge planning on admission to evaluate probable post-acute needs and target a transition date
- Care Management:
- Responsible for established Ministry and Regional metrics. Monitoring specific CM/SW outcomes. Participate in regional and system directives
- Conducting a comprehensive assessment of the client’s health and psychosocial needs, including health literacy status and deficits, and develop a case management plan collaboratively with the client and family or caregiver
- Planning with the client, family or caregiver, the primary care physician/ provider, other health care providers, the payer, and the community, to maximize health care responses, quality, and cost effective outcomes
- Facilitating communication and coordination between members of the health care team, involving the client in the decision-making process in order to minimize fragmentation in the services
- Educating the client, the family or caregiver, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, case management, etc., so that timely and informed decisions can be made
- Empowering the client to problem-solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes
- Encouraging the appropriate use of health care services and strive to improve quality of care and maintain cost effectiveness on a case-by-case basis
- Assisting the client in the safe transitioning of care to the next most appropriate level
- Striving to promote client self-advocacy and self-determination
- Advocating for both the client and the payer to facilitate positive outcomes for the client, the health care team, and the payer. However, if a conflict arises, the needs of the client must be the priority
- Bachelor's degree
- California State Registered Nurse License
- 2 year’s acute hospital experience, including 1 year of supervisory experience
- Strong knowledge base or experience in specialty area assigned
- Special Skills/Desirable Qualifications:
- Must be tactful and proficient at conflict resolution.
- Must be able to work well independently and with a team
- Judgment must include ability to make accurate, rapid and long-term decisions under pressure
- Must be able to project a positive self-image. Must be self-motivated
- Must have good oral and written communication skills
- Strong leadership, supervision interpersonal and organizational skills
- Excellent communication skills, both oral and written
- Excellent customer services skills
- Strong problem-solving skills and flexibility
- Demonstrated ability to work independently and self-directed
- Ability to plan, organize, prioritize, evaluate and document
- Excellent presentation skills
- Basic computer skills, Word, Excel, Access and PowerPoint
- Knowledge regarding State and Federal regulations, HMO, PPO and Utilization processes
- Knowledge of Discharge planning and Case Management
- Knowledge of principles and practices of Utilization and Quality Management
- Knowledge of CPT, IDC-9 Coding
- Master's Degree in health care related field
About the ministry you will serve:
Providence Little Company of Mary Medical Center Torrance is a 436-bed non-profit hospital that has served the greater South Bay communities of Los Angeles since 1960. We have a reputation for clinical excellence and sophisticated technology while providing care with a personal, healing touch. In addition to the finest general medical, surgical and critical care services, we offer a number of specialty programs including Cardiovascular Services, Women’s and Children’s Health, Oncology, and Emergency Care. We are proud to be named one of the Top 50 U.S. Hospitals for Heart Care by Thomson Reuters, the only community hospital in California to receive this honor. We were one of five hospitals in the United States recognized by American Hospital Association-McKesson for leadership and innovation in quality improvement. We received The Choice Award by AAHCP for Outstanding Customer Service Delivery, and were one of 24 hospitals and health systems in the nation to receive the Premier Award for Quality by the Premier healthcare alliance. As a member of Providence Health & Services, a Catholic-sponsored healthcare ministry, we believe strongly in respecting the dignity of each person, and give special concern to the most vulnerable members of our community.
For information on our comprehensive range of benefits, visit:http://www.providenceiscalling.jobs/rewards-benefits
Our Mission As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
About Us Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable.Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression,sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.