University of Southern California

Research university in Los Angeles, CA

Case Manager - Case Management

Medical, Clinical & VeterinaryUpdated on Nov 13

Part-timeLos Angeles, CA, USA$47.31 - $100 /hrIn-person

About the Job

Requirements

An Associate’s Degree in Nursing is required.
Three years of clinical experience is required.
Knowledge of case management principles and healthcare management is required.
Problem-solving skills and the ability to multitask are required.
A Registered Nurse license from the California Department of Consumer Affairs is required.
Basic Life Support Healthcare Provider certification from the American Heart Association is required.
Fire Life Safety Training for Los Angeles City is required; if the applicant does not have the card upon hire, it must be obtained within 30 days of hire and maintained through renewal before expiration.

Responsibilities

Provide care coordination services in collaboration with the interdisciplinary team by evaluating options and services required to meet individual health care needs and promote cost-effective, quality outcomes.
Serve as a consultant to members of the health care team in managing specific patient populations.
Integrate utilization management, quality management, discharge planning assessment, and coordination of post-hospital care services, including transfers to an alternative level of care.
Manage a caseload of 18–20 patients using the online work list to manage daily assignments.
Assess patients’ physical and biopsychosocial needs through clinical assessment and data from multiple sources.
Analyze and interpret data in collaboration with patients, families, physicians, and the health care team to develop a plan of care.
Ensure that a physician-specific plan of care is in place for all patients.
Participate in interdisciplinary meetings.
Initiate a discharge planning assessment within 24 business hours of admission and document it in the computer system.
Assess ongoing discharge planning needs and document changes to the plan in the computer system.
Work collaboratively with social workers to ensure patients’ psychosocial needs are met.
Participate in physician and unit rounds.
Complete Medicare One Day Stay forms and disposition forms for Medicare patients in a timely manner.
Serve as a consultant to the health care team to identify financial issues that may affect care.
Educate health care team members on current healthcare issues impacting practice patterns and reimbursement.
Educate physicians and the health care team on observation status, as appropriate.
Represent the department professionally and assist with orientation of new staff.
Delegate and assist with supervision of Case Management Assistants.
Make appropriate referrals to the Physician Advisor and communicate accurate clinical information.
Participate in InterQual competency testing as requested by the department director.
Participate in the core measure process to identify appropriate patients.
Participate in hospital quality improvement processes and help identify opportunities to improve care.
Adhere to TENET policies and procedures.
Identify compliance and ethical issues and report them appropriately.
Respect patient and family values and beliefs, respond promptly to their requests, support them with end-of-life issues and appropriate referrals, and include them in care decisions and discharge planning.
Assist the health care team in identifying patient and family educational needs for discharge.
Inform patients and families of discharge plans and work with post-acute services to address educational needs and ensure a safe discharge plan.
Propose alternative treatment options to ensure a cost-effective and efficient plan of care.
Identify and create solutions to remove barriers that may impede optimal patient care.
Identify and document avoidable delays in the M drive.
Maintain awareness of current managed care contract requirements and participate in the appeal process.
Perform and document InterQual assessments upon admission, upon a change in level of care, at least every three days, and upon discharge.
Complete clinical reviews in a timely manner and communicate them to the appropriate payer.
Prioritize clinical reviews and document payer communications and authorizations in the authorization log.
Complete and submit TARs for processing within three working days of patient discharge.
Timely notify the director and Physician Advisor of patients who do not meet InterQual criteria.
Perform other duties as requested or assigned.

Desired Qualifications

A Bachelor’s Degree in Nursing is preferred.
One year of case management or utilization review experience within the last three years is preferred.

In collaboration with the interdisciplinary team, provides care coordination services evaluating options and services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care team in the management of specific patient populations. The RN case manager role integrates the functions of utilization management, quality management, discharge planning assessment, and coordination of post-hospital care services, including transfers to an alternative level of care.

Essential Duties

Clinical Care Coordination • Able to effectively manage a case load of 18-20 patients • Utilizes the on line Work list to manage daily assigned caseload. • Assess physical and biopsychosocial needs of the patient through clinical assessment and utilizing data from multiple sources. • Analyze and interpret data in collaboration with patient, family, physician, health care team to develop a plan of care. • Ensures that a physician specific plan of care is in place for all patients. • Actively participates in interdisciplinary meetings. • Initiates a discharge planning assessment within 24 business hours of admission and documents in computer system. • Assesses ongoing discharge planning needs and documents is computer system as changes to the plan occur. • Demonstrates collaborative working relationship with social workers to ensure patient psychosocial needs are met. • Participates in physician and unit rounds. • Completes Medicare One Day Stay forms timely. • Completes disposition form for medicare patients timely.
Consultant • Demonstrates sound clinical knowledge base. • Serves as a consultant to the health care team to identify financial issues that may affect care. • Participates in the education of health care team members on current healthcare issues impacting practice patterns and reimbursement. • Educates physicians and health care team on observation status, as appropriate.
Leadership • Represents the department in a positive and professional manner. • Assists with orientation of new staff. • Delegates and assists with supervision of Case Management Assistants. • Makes appropriate referrals to Physician Advisor, communicating accurate clinical information. • Participates in InterQual competency testing as requested by department director.
Outcomes Management • Participates in core measure process in identification of appropriate patients. • Participates in hospital quality improvement processes and helps identifies opportunities to improve care. • Adheres to TENET policies and procedures. • Identifies compliance and ethical issues and reports appropriately.
Patient Advocacy • Respects patient/family values and beliefs. • Responds promptly to patient/family requests. • Supports patient/family with end of life issues, making appropriate referrals. • Include patient/family in care decisions and discharge planning.
Patient Education • Assist health care team with identification of patient/family educational needs for discharge. • Inform patient/family of discharge plans. • Work with post acute services to address educational needs to ensure a safe discharge plan.
Resource Management • Proposes alternative treatment options to ensure a cost effective and efficient plan of care. • Identifies and creates solutions to remove barriers that may impede optimal patient care. • Identifies and documents avoidable delays in the M drive. • Maintains awareness of current managed care contract requirements. • Participates in appeal process. • Performs and documents InterQual assessments upon admission • Performs and documents InterQual assessments upon a change in level of care • Performs and documents InterQual assessments at least every three days • Performs and documents InterQual assessments upon discharge. • Completes clinical reviews timely and communicates to appropriate payer. • Able to prioritize clinical reviews. • Documents payer communication and authorization in the Authorization log. • Completes and submits TAR’s for processing within 3 working days of patient discharge. • Notifies director and physician advisor timely of patients who do not meet InterQual criteria. • Other duties as requested or assigned.

Required Qualifications:

Req Associate’s Degree Nursing

Req 3 years Clinical experience.

Req Knowledge of case management principles and healthcare management.
Req Problem solving skills and ability to multi-task.

Preferred Qualifications:

Pref Bachelor’s Degree Nursing
Pref 1 year Case management or utilization review experience within the last three years preferred.

Required Licenses/Certifications:

Req Registered Nurse - RN (CA DCA)
Req Basic Life Support (BLS) Healthcare Provider from American Heart Association
Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The hourly rate range for this position is $47.31 – $100.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to theBackground Screening Policy Appendix Dfor specific employment screen implications for the position for which you are applying.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at [email protected]. Inquiries will be treated as confidential to the extent permitted by law.

If you are a current USC employee, please apply to this USC job posting in Workday by copying and pasting this link into your browser:

https://wd5.myworkday.com/usc/d/inst/1$9925/9925$143281.htmld

About the Company

University of Southern California

Research university in Los Angeles, CA

The University of Southern California is a private research university with academic programs across the arts, sciences, business, engineering, law, health, and other professional fields.

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