- Clinical Care Coordination
• Able to effectively manage a case load of 18-20 patients
• Utilizes the on line Work list to manage daily assigned caseload.
• Assess physical and biopsychosocial needs of the patient through clinical assessment and utilizing data from multiple sources.
• Analyze and interpret data in collaboration with patient, family, physician, health care team to develop a plan of care.
• Ensures that a physician specific plan of care is in place for all patients.
• Actively participates in interdisciplinary meetings.
• Initiates a discharge planning assessment within 24 business hours of admission and documents in computer system.
• Assesses ongoing discharge planning needs and documents is computer system as changes to the plan occur.
• Demonstrates collaborative working relationship with social workers to ensure patient psychosocial needs are met.
• Participates in physician and unit rounds.
• Completes Medicare One Day Stay forms timely.
• Completes disposition form for medicare patients timely. - Consultant
• Demonstrates sound clinical knowledge base.
• Serves as a consultant to the health care team to identify financial issues that may affect care.
• Participates in the education of health care team members on current healthcare issues impacting practice patterns and reimbursement.
• Educates physicians and health care team on observation status, as appropriate. - Leadership
• Represents the department in a positive and professional manner.
• Assists with orientation of new staff.
• Delegates and assists with supervision of Case Management Assistants.
• Makes appropriate referrals to Physician Advisor, communicating accurate clinical information.
• Participates in InterQual competency testing as requested by department director. - Outcomes Management
• Participates in core measure process in identification of appropriate patients.
• Participates in hospital quality improvement processes and helps identifies opportunities to improve care.
• Adheres to TENET policies and procedures.
• Identifies compliance and ethical issues and reports appropriately. - Patient Advocacy
• Respects patient/family values and beliefs.
• Responds promptly to patient/family requests.
• Supports patient/family with end of life issues, making appropriate referrals.
• Include patient/family in care decisions and discharge planning. - Patient Education
• Assist health care team with identification of patient/family educational needs for discharge.
• Inform patient/family of discharge plans.
• Work with post acute services to address educational needs to ensure a safe discharge plan. - Resource Management
• Proposes alternative treatment options to ensure a cost effective and efficient plan of care.
• Identifies and creates solutions to remove barriers that may impede optimal patient care.
• Identifies and documents avoidable delays in the M drive.
• Maintains awareness of current managed care contract requirements.
• Participates in appeal process.
• Performs and documents InterQual assessments upon admission
• Performs and documents InterQual assessments upon a change in level of care
• Performs and documents InterQual assessments at least every three days
• Performs and documents InterQual assessments upon discharge.
• Completes clinical reviews timely and communicates to appropriate payer.
• Able to prioritize clinical reviews.
• Documents payer communication and authorization in the Authorization log.
• Completes and submits TAR's for processing within 3 working days of patient discharge.
• Notifies director and physician advisor timely of patients who do not meet InterQual criteria.
• Other duties as requested or assigned.Required Qualifications: - Req Specialized/technical training Graduate of an accredited school of registered nursing
- Req 3 years Clinical experience.
- Req Knowledge of case management principles and healthcare management.
- Req Problem solving skills and ability to multi-task.Preferred Qualifications:
- Pref Bachelor's degree
- Pref 1 year Case management or utilization review experience within the last three years preferred.Required Licenses/Certifications:
- Req Registered Nurse - RN (CA DCA)
- Req Basic Life Support (BLS) Healthcare Provider from American Heart Association
- Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
The hourly rate range for this position is $ $88.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. -
RN Staff
1 day ago
Keck Medicine of USC Los Angeles, CA - Health Sciences Campus, United States Full timeAs an integral part of the interdisciplinary team, the Registered Nurse utilizes the nursing process to provide therapeutic care to patients. The Registered Nurse is accountable for the coordination of patient care and education to the patient and family in accordance with the st ...
-
Utilization Management Specialist
3 weeks ago
Keck Medicine of USC Los Angeles, CA - Health Sciences Campus, United States Full timeThe Utilization Management Specialist coordinates communication with admitting financial counselors, case management, patient financial services, and payers to ensure all inpatient services provided by the hospital are authorized by appropriate payer. The Utilization Management S ...
-
Patient Flow Coordinator
1 week ago
Keck Medicine of USC Los Angeles, CA - Health Sciences Campus, United States Full timeThe Patient Flow Coordinator has primary responsibility for facilitating transfers from outside facilities and managing patient flow and bed placement. The Patient Flow Coordinator interacts with physicians, nursing staff, CAS, PACU, clinic staff, and EVS to effectively communica ...
-
Support Coordinator
3 days ago
Keck Medicine of USC Los Angeles, CA - Health Sciences Campus, United States Full timeThe Support Coordinator will assist with all aspects of patient care. Coordinate clinic schedules, patient appointments and follow up. Answers patient phone calls, verify insurance benefits, prepare charts for clinic and prepare charge tickets for clinic visits. He/She will also ...
-
Transplant Coordinator I, RN
4 weeks ago
Keck Medicine of USC Los Angeles, CA - Health Sciences Campus, United States Full timeDevelops and maintains nursing practice standards of care for a specific transplant population. Serves as a liaison and provides consultation and education services to support standards of care. Identifies and resolves clinical issues relating to the transplant patient. Collabora ...
-
Program Administrator
1 day ago
Keck Medicine of USC Los Angeles, CA - Health Sciences Campus, United States Full timeThe Program Administrator administers the Remote Second Opinion (RSO) program, including but not limited to the development, implementation, and evaluation of health-focused program policies, goals, and objectives, program administration/organization/planning, financial performan ...
-
Sterile Processing Technician III
3 weeks ago
Keck Medicine of USC Los Angeles, CA - Health Sciences Campus, United States Full timeUnder general supervision of the Sterile Processing Supervisor or Sterile Processing Educator, the Sterile Processing Technician (SPT)III serve with basic knowledge of Sterile Processing techniques/skills and is responsible for decontaminating, operationally checking, assembling, ...
-
Supervisor, Advanced Practice Provider
1 month ago
Keck Medicine of USC Los Angeles, CA - Health Sciences Campus, United States Full timeThe Supervisor works under the direction of the Associate Administrator of Advance Practice Providers, Department's Administration, and Medical Directors to provide both clinical services as well as leadership and managerial services . The Supervisor will facilitate safe and effi ...
-
RN Coordinator
3 days ago
Keck Medicine of USC Los Angeles, CA - Health Sciences Campus, United States Full timeThe Wound Management Program Nurse Coordinator has the responsibility and accountability for development and facilitation of all clinical aspects of the skin injury prevention program. This position will be responsible for ensuring that all relevant clinical policies and practice ...
Case Manager, RN - Los Angeles, CA - Health Sciences Campus, United States - Keck Medicine of USC
Description
In collaboration with the interdisciplinary team, provides care coordination services evaluating options and services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care team in the management of specific patient populations. The RN case manager role integrates the functions of utilization management, quality management, discharge planning assessment, and coordination of post-hospital care services, including transfers to an alternative level of care.
Essential Duties: