Case Manager Utilization Management & Review at Loma Linda

Loma Linda, California, United States -

Full Time

Start Date

Immediate

Expiry Date

30 May, 26

Salary

79.6

Posted On

01 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Expertise, Independent Judgement, Assessment, Care Planning, Intervention, Evaluation, Case Management, Utilization Management, Interdisciplinary Plan Of Care, Discharge Planning, Change Agent, Critical Thinking, Organization, Prioritization, Problem Solving, Attention To Detail

Industry

Hospitals and Health Care

Description

Alternating weekend required, may work holidays depending on departmental needs. Job Summary: The Case Manager serves as a key member of the patient care delivery team in a Magnet Recognized large tertiary academic medical center with level one trauma designation, ST-Elevation Myocardial Infarction (STEMI) receiving center designation, and Comprehensive Stroke Center and Chest Pain Center accreditation. Works efficiently in a fast-paced environment and utilized clinical expertise, discretion and independent judgement in performing the nursing process (assessment, care planning, intervention, evaluation) within a patient-centered care professional practice model (Duffy's Quality-Caring Model) and as it relates to case management functions. Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria (medical necessity) are met for level of care provided and is documented from admission through discharge. Practices in a collaborative health care environment to oversee implementation of a well-thought-out interdisciplinary plan of care with an individualized discharge plan that is comprehensive and best meets the continuing healthcare needs of the patient. Reevaluates plan of care and ensures continued appropriateness based on the patients changing needs and condition. Functions within the expectations of a professional nurse and meets nursing excellence standards to achieve and maintain Magnet Recognition as outlined by the American Nurses Credentialing Center. Represents nursing as an empowered profession and readily embraces new knowledge, innovations and improvements. Exhibits positivity and serves as an instrumental change agent and expertly minimizes resistance to change in the workforce, clinical practice and operational setting. Engages in opportunities to directly and/or indirectly influence decision-making for bedside clinical practice by participating in professional governance councils, committees, taskforces and staff meetings. Performs other duties as needed. and practices. Demonstrates ability to be an effective change-agent for implementation of new processes to achieve desired outcomes/performance measures. Performs other duties as needed. Education and Experience: Bachelor of Science degree in nursing (BSN) required. Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge and Skills: Basic knowledge of case and utilization management practice and methodologies and state and federal healthcare regulations and accreditation required. Able to: speak, read and write legibly in English (and Spanish preferred) with professional quality; use computer, printer and software programs necessary to the position, e.g., Microsoft Office Suite, Outlook, electronic medical record, electronic event reporting program. Relate and communicate positively, effectively and exhibit professional behavior at all times; work calmly and respond courteously when under pressure; be assertive and consistent in following policies; teach, and collaborate; accept direction; think critically; work independently with minimal supervision; perform basic math and statistical functions; manage multiple assignments effectively; organize and prioritize workload; problem solve; recall information with accuracy; pay close attention to detail; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the work place; see adequately to read computer screens, medical records, and written documents necessary to position. Licensures and Certifications: Active and unrestricted California Registered Nurse (RN) license required. Current Basic Life Support (BLS) certification issued by the American Heart Association required. Nationally recognized certification in Utilization Management or Case Management preferred. Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, excellence, humility, integrity, justice, teamwork and wholeness. Loma Linda University Health is a Seventh-day Adventist, faith and values based Christian institution. Candidates must understand and embrace the mission, purpose, and identity of Loma Linda and its affiliated entities. We are an equal opportunity employer committed to the principles of diversity. We provide equal opportunities in all aspects of the employment process to every individual, regardless of gender, race, color, age, national origin, ancestry, physical or mental disability, marital or veteran status, genetic information or any other characteristic protected by law. In addition, we will provide reasonable accommodations for otherwise qualified individuals requesting an accommodation due to a disability. If you need accommodation assistance with accessing our job listings or completing an application, or during any other phase of employment with us, please contact Human Resources Management at (909) 651-4001. Loma Linda University Medical Center is a religiously-qualified Equal Opportunity Employer under Title VII of Civil Rights Act of 1964. No question on this application is asked for the purpose of unlawfully limiting or excluding any applicant’s consideration for employment because of race, color, religion, gender, age, national origin, disability, genetic information, or any other status protected by applicable law. If you need a reasonable accommodation in the hiring process, please notify Human Resource Management. We appreciate your interest in Loma Linda and wish you success in your job search!

Responsibilities

The Case Manager applies clinical expertise to perform the nursing process within a patient-centered care model, ensuring medical appropriateness criteria are met from admission through discharge. This role involves overseeing the implementation of interdisciplinary care plans and reevaluating them based on the patient's changing needs.