Job DescriptionJoin Cedars-Sinai!Cedars-Sinai Medical Center has been ranked the #1 hospital in California and #2 hospital in the nation by U.S. News & World Report, 2022‑23Cedars-Sinai was awarded the Advisory Board Company’s Workplace of the Year which is an award that recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We also have a great benefits package and competitive compensation which explains why U.S. News & World Report has named us one of America’s Best Hospitals!Why work here?Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) we take pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation.A Little More About What You Will be DoingThe 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.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.
Begins discharge planning and care assessment within one working day (preferably on day of admission).
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.
For patients who are transitioning to the Skilled Nursing Facilities, refers to nurse practitioner and case manager assigned to the SNF’s for continued review and follow up.
Authorizes all appropriate services based upon covered benefits and necessity of care provided.
Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate.
Coordinates the patient’s care with other health care personnel to ensure that the patient receives care timely post discharge.
Secures outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers.
Refers to Ambulatory Case Manager patients identified that will need oversight of outpatient care and compliance to avoid unnecessary readmissions.
Coordinates referrals and secure appointment with various CSMNS disease management programs.
Enters and updates all authorization and clinical information into Nautilus (Access Express) no later than date of discharge.
QualificationsEducation:
RN graduate of an accredited RN program required
Graduation from accredited Medical Assisting from an accredited educational program and/or Medical Assistant Certification from Board approved Medical Assistant Organization
Experience:
3 years acute nursing experience, knowledge of medical/nursing standards of care preferred
1 year Previous experience in case management in the acute inpatient or outpatient settings; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings preferred
Licenses/Certification:
Basic Life Support (BLS) from American Heart Association or American Red Cross required
Certified Case Manager (CCM) preferred
About UsCedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.About the TeamWith a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai’s medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.Req ID : 1758Working Title : Care Coordinator - RNDepartment : MNS ISPBusiness Entity : Cedars-Sinai Medical CenterJob Category : Patient ServicesJob Specialty : Case ManagementOvertime Status : NONEXEMPTPrimary Shift : DayShift Duration : 8 hourBase Pay : $48.21 - $77.14Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.