The RN ED Access Case Manager provides care coordination which emphasizes positive partnerships with nursing, physicians, and other key disciplines in order to coordinate admissions, transfers and repatriation to PIH Health Hospitals through the emergency room or direct admission. The RN ED Access Case Manager works closely with insurance and various payor to coordinate and assist with repatriation / transfer of out-of-network patients from PIH Health Hospitals to the patient’s contracted facility. The RN ED Access Case Manager performs utilization review with a high level of expertise by using criteria that demonstrates medical necessity to achieve authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, Outpatient). RN ED Access Case Manager also provides oversight of hospital bed control system and work in collaboration with House Supervisor to ensure appropriate placement of patients to the right level of care. The RN ED Access Case Manager works to ensure appropriate utilization of hospital resources in all settings and levels of care. The RN ED Access Case Manager is also responsible for completing discharge orders of patients discharge from the emergency department. Works closely with Care Management Coordinators in arranging delivery of DMEs, post emergency visit care including but not limited to coordinating discharges to SNFs, Subacutes, LTACs, Hospice, Home with and without home health services, or arranging various follow up appointments. Communicates effectively with patients, families, and other healthcare teams as necessary about various care coordination of patients in the emergency department of PIH Heath Hospitals.
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 Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services.
The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work ^TM . For more information, visit PIHHealth.org or follow us on Facebook , Twitter , or Instagram .
Required Skills
Required Experience
Preferred :
Be yond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M / F / D / V
Address
11500 Brookshire Ave.
Salary
Shift
Variable
Rn • DOWNEY, CA, US