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Under the general supervision of the case management Director acts as a patient advocate/case manager to hospital clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. Looks for opportunities to reduce cost while ensuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care. Works collaboratively with interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care.
Under the general supervision of the case management Director acts as a patient advocate/case manager to hospital clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. Looks for opportunities to reduce cost while ensuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care. Works collaboratively with interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care.
Two years of Case Management experience in an acute care environment preferred. Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking. Knowledge of healthcare financing, community and organizational resources, patient care processes, and data analysis. Knowledge of utilization management as it relates to third-party payers. Experience with managed care preferred. Excellent verbal and written communication skills required. Demonstrates flexibility via an ability to adapt to changing priorities and regulations.
BSN or MSW preferred. Current California RN and BLS certification required.
Other
$99k-119k (estimate)
03/16/2023
12/19/2025
ahmchealth.com
Alhambra, CA
1,000 - 3,000
The following is the career advancement route for Case Manager, RN positions, which can be used as a reference in future career path planning. As a Case Manager, RN, it can be promoted into senior positions as a Case Management Director that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Case Manager, RN. You can explore the career advancement for a Case Manager, RN below and select your interested title to get hiring information.