Overview The Case Manager serves as a key member of the patient care delivery team in a Magnet Recognized large tertiary academic medical center with level one trauma designation, STEMI receiving center designation, and Comprehensive Stroke Center and Chest Pain Center accreditation. Works in a fast-paced environment using clinical expertise, discretion and independent judgment in performing the nursing process (assessment, care planning, intervention, evaluation) within a patient-centered care professional practice model and as it relates to case management functions. Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria (medical necessity) are met for level of care provided and is documented from admission through discharge. Collaborates to oversee implementation of an interdisciplinary plan of care with an individualized discharge plan that best meets continuing healthcare needs. Reevaluates plan of care and ensures continued appropriateness based on changing patient needs and condition. Supports nursing excellence standards to achieve and maintain Magnet Recognition as outlined by the American Nurses Credentialing Center. Participates in professional governance and committees to influence bedside clinical practice. Performs other duties as needed.
Responsibilities Apply case management and utilization management methodologies in daily practice and ensure alignment with medical necessity criteria and documentation from admission through discharge.
Collaborate with an interdisciplinary team to develop and implement a comprehensive discharge plan tailored to the patient’s evolving needs.
Engage in professional governance activities, committees, and staff meetings to influence nursing practice and operational performance.
Demonstrate change-agent capabilities to implement new processes and improved outcomes while minimizing resistance in the clinical setting.
Perform other duties as needed.
Education and Experience Bachelor of Science degree in nursing (BSN) required.
Minimum two years of hospital nursing experience required.
Minimum two years of case management, utilization review, or discharge planning experience in an acute care environment preferred.
Knowledge and Skills Basic knowledge of case and utilization management practice and methodologies; understanding of state and federal healthcare regulations and accreditation requirements.
Proficiency in English (Spanish preferred) with professional quality written and verbal communication.
Computer literacy including Microsoft Office Suite, Outlook, electronic medical record systems, and reporting tools.
Ability to relate and communicate professionally, remain calm under pressure, follow policies, teach, collaborate, think critically, work independently, manage multiple assignments, prioritize workload, and solve problems.
Licenses and Certifications Active and unrestricted California Registered Nurse (RN) license required.
Current Basic Life Support (BLS) certification issued by the American Heart Association required.
Nationally recognized certification in Utilization Management or Case Management preferred.
About Us Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, excellence, humility, integrity, justice, teamwork and wholeness.
About The Team Loma Linda University Health is a Seventh-day Adventist, faith and values based Christian institution. Candidates must understand and embrace the mission, purpose, and identity of Loma Linda and its affiliated entities.
Equal Opportunity We are an equal opportunity employer committed to the principles of diversity. We provide equal opportunities in all aspects of the employment process to every individual, regardless of gender, race, color, age, national origin, ancestry, physical or mental disability, marital or veteran status, genetic information or any other characteristic protected by law. In addition, we will provide reasonable accommodations for otherwise qualified individuals requesting an accommodation due to a disability. If you need accommodation assistance with accessing our job listings or completing an application, or during any other phase of employment with us, please contact Human Resources Management at (909) 651-4001.
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