Coordinator of Case Management
Location:
Riverside , California
Posted:
September 07, 2017
Reference:
07150-7031
Founded in 1901, Riverside Community Hospital is a 373 licensed bed, full-service acute care hospital in the heart of the Inland Empire. RCH has been recognized as a Top Performing Hospital and has invested in a new campus expansion project that includes a new 7 story patient tower, 3 story medical office building, and a recently completed 5 level state of the art parking garage. With over 500 physicians on staff, representing over 200 specialties and over 1,900 employees, Riverside Community Hospital is an Inland Empire leader in providing advanced, comprehensive health care to the Inland region. RCH houses the largest Emergency Room and Trauma Center in the Inland Empire at 50 beds with an average wait time of only 15 minutes. RCH is one of Riverside County's only STEMI receiving centers and is a fully accredited Chest Pain Center. Centers of Excellence include the HeartCare Institute, offering invasive and non-invasive cardiac procedures, Center of Excellence for Surgical Weight Loss, the Transplant Program and a Level II Neonatal Intensive Care Unit.

COORDINATOR CASE MANAGEMENT
  • Manages the process to review and, as appropriate, appeal denials received from payers.
  • 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.
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.

Qualifications:
Required Job Qualifications include:
  • Current licensure as an RN
  • Graduate of an accredited school of professional nursing. Bachelors of Science in Nursing preferred.
  • CCM preferred
  • Minimum 2 years of acute care case manager experience
  • Knowledge of CMS guidelines and experience working with payer 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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