Job - RN - Clinical Case Manager - Resource

UCLA HEALTH - Westwood, California

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RN - Clinical Case Manager - Resource

UCLA HEALTH - Westwood - CA Careers Responsibilities
Responsibilities

The Resource Case Manager is responsible for high-level assessment and planning for an identified group of patients. Collaborates with the attending, resident and intern medical staff, as well as nursing, ancillary, professional, and technical staff to coordinate the delivery of high quality, individualized, cost-effective patient care. Coordinates resource utilization and evaluates services provided. Coordinates interdisciplinary referrals to assure the delivery of post-hospital services. Performs the appropriate utilization review functions utilizing approved Intensity of Service, Severity of Illness criteria. Concurrently intervenes to enhance patient quality outcomes where appropriate. Brings support to the performance improvement process by comprehensive analysis of patterns and trends. Acts as a consultant to the care coordination team, clinical team, and other departments. Obtains medical authorizations/certifications, when appropriate. Determines level of care or medical necessity using predetermined criteria such as: The UCLA developed Level of Care, the Severity of Illness and Intensity of Services (SIIS), Medicare or Medi-Cal guidelines, or other criteria which is deemed appropriate. Reviews prospectively, concurrently, and retrospectively all in patients for appropriateness of admission, level of care, and determines appropriate length of stay. Monitors patients’ length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient’s clinical and psychosocial needs.

Qualifications

RN license is required, BSN required, and MSN Preferred.
Minimum of three years of acute hospital experience; or the equivalent of education and experience.
Recent experience in case management, utilization management, or discharge planning. Team leading or management experience. Self-directed, assertive and creative in problem solving, systems planning and patient care management in a high volume work environment. Demonstrates resourcefulness, effective written and oral communication, diplomacy, organizational, and analytical skills (Required). Ability to work effectively and collaboratively with interdisciplinary teams. Basic working knowledge of a large University teaching hospital; its purpose and functions Official Transcripts and/or original diploma from a registered nursing program must be provided upon hire

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