Case Manager II
Location:
Thousand Oaks , California
Posted:
November 21, 2017
Reference:
00048-7513
Los Robles Hospital & Medical Center is a licensed 404 bed acute care facility. Fully accredited by the Joint Commission, Los Robles Hospital has the only Level II Trauma Center in Eastern Ventura County and the only Emergency Room in both Los Angeles and Ventura counties coveted EDAP (Emergency Department Approved for Pediatrics) rating.
In addition, it is the only hospital certified by both counties as a STEMI designated heart attack center for rapid heart attack response and is a certified Primary Stroke Center. With over 600 physicians on its medical staff, representing over 50 medical specialties, Los Robles is proud to be the community's most trusted resource for health and a regional destination for care.

The RN Case Manager works with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge. The tasks and responsibilities include:

  • Performs continuous assessments and evaluations to ensure patient is progressing towards desired outcomes.
  • Assesses and responds to patient/family needs by coordinating efforts of other team members.
  • Identifies and resolves barriers that hinder effective patient care.
  • Collaborates and consults with physicians on patient's progress and discharge planning needs.
  • Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity.
  • Manages the process to review and, as appropriate, appeal denials received from payors.
  • Coordinates the discharge planning process ensuring involvement of all members of the healthcare team. Counsels with patients and family members in decision making and in meeting psycho social needs of the patient.
  • Maintains knowledge of resources and facilities available to patients and family members.
  • Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions.
  • Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities.
  • Provides age and culturally appropriate care.
  • Orients and mentors new staff members.
  • Follows Standard Precautions using personal protective equipment as required.

Qualifications:
Required Job Qualifications include:
  • Current licensure as an RN
  • Graduate of an accredited school of professional nursing. Bachelor's of Science in Nursing preferred.
  • CCM preferred
  • Minimum 5 years of clinical nursing experience.
  • Knowledge of CMS guidelines and experience working with payor specific guidelines and contractual rules preferred.
  • Customer service abilities including effective listening skills.
  • Critical thinking skills, decisive judgment and the ability to work with minimal supervision meeting firm deadlines.
  • Assertive and persuasive communication skills, action oriented.

A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom

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