CARE MANAGER I (RN) - CARE MANAGEMENT (UTILIZATION REVIEW)

Salary Range: $47.7200 - $73.3700 /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education.

Case Manager – RN (Utilization Review)

Do you thrive on supporting the professional face of a hospital dedicated to serving the community? Do you have strong customer service expertise and are you passionate about working with patients and clinical teams to deliver high-quality service that makes a difference? Are you ready to take on the challenge of creating an exceptional patient experience from the moment they check in? If you said yes, keep reading – we may have the perfect opportunity for you. 

As the Care Manager RN for Hoag Memorial Hospital, Newport Beach, you’ll be responsible for utilizing your clinical expertise, discretion, and independent judgement to assess patients’ needs and coordinate post-acute care in order to provide for a safe discharge. Being a Care Manager RN means working in collaboration with physicians, nurses, ancillary staff, and community agencies to identify and arrange for appropriate patient care.  

Inside the Care Management Department  

Our Care Management team provides stream-lined coordination of patient care services to Hoag patients and families. From admission to post-discharge, our Care Management team is there to assure care is appropriate, timely, cost-effective, and of high quality. We look to our Care Managers to fully support and provide the Hoag Experience for our patients. We know you’ll love working in our team environment, and hope you’ll bring with you excellent communication and teamwork skills, effective listening skills, and strong customer service expertise. 

Other duties include: 

• Developing and implementing discharge plans for patients; this includes assessment of clinical, psychosocial, and financial needs of the patient and family. 
• Coordinating with the interdisciplinary team to gather pertinent clinical information in order to develop a comprehensive discharge plan. 
• Maintaining knowledge of clinical course of patient’s condition in order to appropriately identify post-acute care medical and psychosocial needs. 

• Assisting the physicians and care team with decision making on transfers for clinically complex patients to higher level of care and ensuring clinical information is passed on to the next care provider.  
• Overseeing the post-acute care arrangements for patients on ECMO or home ventilators. 
• Understanding of payer requirements for discharge. 
• Communicating and coordinating with resources in the community to meet the clinical and psychosocial needs of the patient for a safe discharge. This includes providing patient information within the guidelines of HIPPA. 
• Educating the patient on community and government resources to assist the patient with developing short/long term care plans. 

• Assisting patient to advocate for self to receive appropriate services. 
• Documenting pertinent patient issues, contacts and discharge plans in the medical record. 
• Maintaining appropriate utilization of resources during and post hospitalization. 
• Participating in achieving metrics established by the hospital to meet CMS quality standards, HCPS, Magnet and other hospital initiatives.  
• Understanding of the responsibility to be a mandated report for elder, child, and spousal abuse. 

• Completing mandatory stroke specific competencies as applicable. 

Hoag employees consistently maintain a high standard of professional communication, appearance, and conduct. They’re driven to excel, and they’re deeply passionate about their work. To that end, we’ll expect you to participate in our continuous quality improvement process and maintain a working knowledge of departmental and hospital standards, policies and procedures. 

We’re keen on following safety measures and infection control protocols, being attentive to details, and having intimate knowledge of the populations we serve. 

Hoag is the Place to Be 

We believe that when you join Hoag, you become part of a family. We’re deeply committed to giving back to those who help us serve our community, making your ongoing growth and development as a nurse our priority. In addition to Pay for Performance salary increases, and sponsored training opportunities, Hoag employees enjoy: 

• Annual performance incentives 
• Safe Harbor bonuses 

• Competitive 401 (k) program with matching contributions 
• Generous Paid Time Off (PTO) 
• Nursing Scholarships 
• Tuition Reimbursement 
• Nursing Clinical Ladder Program  

• On-site childcare at our Newport Beach location 
• Excellent Medical, Dental and Vision coverage 
• On-site Wellness Centers at our Irvine and Newport Beach campuses that include discounted services for massage therapy, acupuncture, meditation and mindfulness, yoga, Pilates and fitness coaches 

We look for passion, an ownership mentality, and out-of-the-box thinking. If this is you and Hoag sounds like home, please apply. A member of our Talent Acquisition Team will contact you if they want to know more. 

Required 

• Current RN License, in good standing, within the State of California 
• Bachelor’s degree in nursing (BSN) 
• Current American Heart Association Healthcare Provider BLS (CPR) Certification 

There’s no Place Like Hoag 

Recently, Hoag was recognized as the highest ranked hospital in Orange County in a 2018-2023 U.S. News & World Report. The organization was also ranked the #4 hospital in the Los Angeles Metro Area and the #8 hospital in California. The Association for Healthcare Philanthropy recognized 52 U.S. and Canadian nonprofit organizations as high-performing fundraisers in the North American healthcare industry for the fiscal year 2015. Forty of 52 were U.S. hospital systems.  

We’re an industry leader at the cornerstone of exceptional patient care – but we can’t do it without you. 

To learn more about us and see our culture in action, check out this video on YouTube. 

Join the conversation and follow us on Twitter, Instagram, and LinkedIn @hoagcareers. 

Hoag is an equal opportunity employer 

Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.