RN Case Manager
On-siteCosta Mesa, California, United States
Job Summary
Manage the continuum of care from admission through discharge for assigned patients by partnering with medical staff, utilizing scientific evidence, and implementing evidence-based nursing care practices. Participate in developing and modifying patient-focused long and short-term goals while collecting and reporting utilization data, quality information, and readmission metrics. Collaborate with nursing staff in care areas, consult on client needs, and provide instruction to hospitalized members and their families. Ensure accurate and timely documentation in the EMR system every shift, prepare UM/QI case issues, and evaluate employee performance through completed work assignments. Liaise between the member, physician, hospital, and Plan to ensure quality care and continuous improvement of agency efficiency.
Required Qualifications
- Active CA Registered Nurse
- Acute clinical experience
- Experienced in case management, UR/UM
- Possesses knowledge of applicable regulatory standards and is able to perform audits based upon these standards
- Solid experience dealing with UR concepts
- Computer literate
- Excellent verbal and written communication skills
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