ED Registered Nurse Access Case Manager, Utilization Management, Full time, Variable shift
Location: Downey, California
Internal Number: 21436
The RN ED Access Case Manager provides care coordination which emphasizes positive partnerships with nursing, physicians, and other key disciplines in order to coordinate admissions, transfers and repatriation to PIH Health Hospitals through the emergency room or direct admission. The RN ED Access Case Manager works closely with insurance and various payor to coordinate and assist with repatriation/transfer of out-of-network patients from PIH Health Hospitals to the patient’s contracted facility. The RN ED Access Case Manager performs utilization review with a high level of expertise by using criteria that demonstrates medical necessity to achieve authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, Outpatient). RN ED Access Case Manager also provides oversight of hospital bed control system and work in collaboration with House Supervisor to ensure appropriate placement of patients to the right level of care. The RN ED Access Case Manager works to ensure appropriate utilization of hospital resources in all settings and levels of care. The RN ED Access Case Manager is also responsible for completing discharge orders of patients discharge from the emergency department. Works closely with Care Management Coordinators in arranging delivery of DMEs, post emergency visit care including but not limited to coordinating discharges to SNFs, Subacutes, LTACs, Hospice, Home with and without home health services, or arranging various follow up appointments. Communicates effectively with patients, families, and other healthcare teams as necessary about various care coordination of patients in the emergency department of PIH Heath Hospitals.
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services.
The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
Excellent verbal, written and organizational skills required
Is organized and able to prioritize and delegate work appropriately
Ability to work in fast-paced environment
Highly developed ability to multitask with aptitude to pay close attention to details and maintain focus
Ability to follow chain of command
Knowledge of medical terminology and current third-party payor reimbursement methodologies
Self-motivated and results oriented
Proactive, can-do approach and desire to build positive working relationships through collaborative problem-solving
Must be able to demonstrate sound decision-making and prioritization of skills
Basic computer skills: Word, Excel, PowerPoint, Outlook. Able to utilize multiple electronic systems. Type 50 WPM
Knowledge of hospital operations especially from an ER, ICU, nursing unit, environmental services and financial perspective
Utilizes the approved process to resolve biophysical, psychological, educational, and environmental needs of patient/significant others when administering or explaining care
Organized and can priority workload effectively and efficiently.
Maintain an active California RN License
Minimum of five (5) years of acute hospital nursing experience
CCM or ACM (Certified Case Manager, Accredited Case Manager)
Minimum of one (1) year acute hospital nursing experience in Critical Care or Emergency Department
Previous experience in case management.
Knowledge of payer requirements and previous experience in case management or bed control.
Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V
PIH Health is the Communities’ Health and Wellness Partner
Our network of highly trained and compassionate physicians, nurses, clinicians, staff and volunteers work tirelessly and collaboratively every day to maintain and enhance the health and wellbeing of every member of our service areas. And when needed, we are here to coordinate care, manage chronic disease, and treat health conditions for the best possible outcomes.
We’re a nonprofit, regional healthcare network with three hospitals, numerous outpatient medical offices, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. Our leadership is dedicated to putting patients first—a cornerstone of our mission, vision and values—as we deliver top-quality healthcare.
We serve more than 3.7 million residents in the Los Angeles County, Orange County and San Gabriel Valley region.
Why PIH Health?
Our culture is built around our core values, which are the guiding principles for everything we do. For over 60 years, PIH Health has maintained a sense of community and a family-like cultur...e where patients are the top priority, and employees and volunteers are proud to be affiliated with such an outstanding organization.
PIH Health Hospital - Whittier
Our Whittier campus delivers outstanding and compassionate care to patients, every day. Among other awards, PIH Health Hospital - Whittier has been named one of the nation’s 100 Top Hospitals® for the third consecutive year by Truven Health Analytics. PIH Health Hospital in Whittier, CA is located 30 minutes east of Los Angeles, close to the Los Angeles and Orange County border. There are many great communities in which to live that surround the hospital. This means easy access to work, great dining, shopping, entertainment and spectacular beaches. Whatever your passion, you’ll find the right place for it here.
PIH Health Hospital - Downey is a nonprofit hospital with a rich, nearly 100-year history of meeting the healthcare needs of its community. The Downey campus is part of the PIH Health comprehensive health network consisting of two hospitals, 18 medical office locations and a host of specialty services. According to US News & World Report, the hospital scores highly in patient safety and orthopedics. With 955 employees, the hospital is the 5th largest employer in the city of Downey.