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Department:  Nursing
Status:  Full Time
Shift:  1st

The Case Manager (RN) utilizes clinical expertise, discretion, and independent judgment to case management and care coordination methodologies and practices, focusing on the needs of Hoag Hospital and its affiliates (the “Organization”) patient population in partnership with the Organization’s physicians, staff, and inpatient providers. The Case Manager (RN) displays and practices a work-style reflecting the mission, vision and values of the Case Management team, as well as the Organization. Participates in the continuous quality improvement process. Maintains a working knowledge of departmental standard operating procedures, including the use of specialized instrumentation, Quality Control requirements, and preventive maintenance.


Essential Functions Case Manager RN (I):

• Comprehensively plans for care management services for patients and their families.

• Carries out activities related to utilization management, determination of post acute clinical care needs (discharge planning) and level of care, care coordination and referral to other levels of care. • Works with interdisciplinary team to facilitate clinical pathways and achievement of desired treatment outcomes.

• Works collaboratively to ensure patient needs are met and care delivery is coordinated.


Case Manager (RN) II:

• Collaborates with the Social Worker in the development of a plan for post acute needs identified in the interdisciplinary Meetings.

• In-depth knowledge of payor source implications for the discharge plan, resources and placement options to maximize a patient's successful discharge.

• Chairs and disseminates necessary clinical and social information to all members of the Interdisciplinary team.

• Utilizes an interdisciplinary process to assess, plan, and provide patient care for specific diagnoses from admission through after care.

• Coordinates and monitors progress toward established discharge goals in a weekly meeting of the Interdisciplinary Team to achieve a smooth transition from admission to discharge.

• Promotes appropriate post-hospital utilization of resources, adequate education of patient and Organization staff, and decreased incidence of re-admission.

• Acts as a resource for patients and staff providing updates on care and options available for discharge. Attends educational meetings to keep current in field.


Case Manager Lead (RN):

• Provide individual and group supervision for the Case Manager (RN) team.

• Monitors Case Manager (RN) patient load for capacity and acuity.

• Monitors and ensures complaints are prioritized and resolved in a timely fashion with appropriate documentation and follow-up as required.

• Identifies areas for improvement and implements improved workflow processes, responding to departmental needs in a timely fashion with minimal impact to patients and Organization staff.

• Drives performance improvement initiatives related to Case Management, including identification of new concepts and processes to reduce patient delays.

• Creates a climate in which people want to work to do their best; inspires and motivates employees to achieve the Organization’s goals; motivates many types of direct reports, teams, or project members; assesses individual motivation and uses knowledge to maximize employee’s contributions.

• Establishes clear responsibilities and expectations for employees, set goals, hold employees accountable and provides proper coaching and developing.

• Performs other duties as assigned


Education, Training and Experience

Required: Case Manager (RN) I:

• Current license to practice as a Registered Nurse (RN) within the State of California.

• Current American Heart Association Healthcare Provider BLS (CPR) certification.


Case Manager (RN) II: In addition to the above, the Case Manager (RN) II will have:

• Bachelors or Masters degree in nursing (BSN, MSN) or social work (BSW, MSW).

• Minimum five (5) years of clinical experience in acute healthcare system environment

• Minimum one (1) year of discharge planning or utilization review in an acute healthcare system environment.

• Knowledge/expertise in Interqual or Millennium Guidelines.


Case Manager Lead (RN):

• Minimum of one (1) years supervisory experience, preferably within Case Management at an acute healthcare system environment, or equivalent combination of education and work experience. Preferred:

• Certification in Utilization Review, Care Management, or Clinical Nursing area certification.


Skills or Other Qualifications Required:

• Self-directed individual with ability to prioritize multiple tasks and meet deadlines, excellent attention to detail, and maintain a high level of work quality.

• Strong team player with excellent oral, verbal and presentation communication skills.

• Proven ability to interface with all customer levels (physicians, Organizational staff, insurance companies, patients and family members).

• Working knowledge of Microsoft Office Suite, including Outlook, Word, Excel, and PowerPoint, plus healthcare database systems.

• Decisive and capable of exercising good judgment under pressure.


• Qualified bilingual or multilingual candidates.


License and Certifications

Required: Case Manager (RN) I, II, Lead:

• Current license to practice as a Registered Nurse (RN) within the State of California.

• Current American Heart Association Healthcare Provider BLS (CPR) certification.


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