The Registered Nurse (RN) Case Manager provides care coordination which emphasizes positive partnerships with nursing, physicians and other key disciplines in order to pace the care for outcomes while meeting core measures within the appropriate level of care. The RN Case Manager provides discharge planning by collaboratively determining level of care needs beyond acute care, providing decision support to patients and families and physicians, managing patient and family expectations and ensuring a smooth transition to the next level of care and services. The RN Case Manager performs utilization review with a high level of expertise by using criteria that demonstrates medical necessity to achieve reimbursement for services and ensuring appropriate utilization of hospital resources.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Excellent verbal, written, and organizational skills required.
• Ability to follow chain of command.
• Knowledge of medical terminology and current third party payor reimbursement methodologies.
• Self-motivated and results oriented.
• Must be able to demonstrate sound decision making and prioritization skills.
• Proficiency with main-frame and personal computers.

Required Experience

Required:

• Maintain an active California RN License.
• Minimum of 5 years hospital nursing experience 

Preferred:

• BSN or MSN degree
• CCM or ACM (Certified Case Manager, Accredited Case Manager)
• Previous experience in case management
• Charge Nurse Experience