RN Care Coordinator - Inpatient Specialty Program - 8-Hour Days - $5,000 Hiring Incentive!!
Join to apply for the RN Care Coordinator - Inpatient Specialty Program - 8-Hour Days - $5,000 Hiring Incentive!! role at Cedars-Sinai .
Job Description
Cedars-Sinai has been named to the Honor Roll for the ninth consecutive year and tied for #1 in California and Los Angeles in U.S. News & World Report’s “Best Hospitals 2024-25” rankings, as well as placed among the very best in 11 specialties nationwide. The RN Care Coordinator is responsible for the case management of patients while hospitalized and upon discharge from various care settings. In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the RN Care Coordinator will assist patients from admission to discharge by assessing needs, coordinating care, communicating with health plans (including concurrent review to determine the appropriateness of services), and ensuring quality, cost-effective care.
Responsibilities
Meets with patients within 24 hours of admission and conducts an initial assessment.
Collaborates with designated hospitalist every day during morning rounds to discuss disposition planning and assess suitability for each patient’s hospital stay.
Reviews with hospitalist the patient’s admission and continued stay for medical necessity, appropriateness of care and level of care. Uses Milliman and Interqual guidelines as necessary.
Collaborates with clinical teams to synchronize operations and conduct utilization review to match payer requirements and ensure appropriate level of care.
Investigates, processes, and assists with the resolution of provider grievances and appeals per contractual requirements and policy.
Begins discharge planning and care assessment within one working day (preferably on day of admission).
Submits necessary clinical information to the health plan using the accepted format (MIDAS or telephonic) and coordinates health plan communication with the assigned hospitalist as appropriate.
For patients transitioning to Skilled Nursing Facilities, refers to the nurse practitioner and case manager assigned to the SNF for continued review and follow-up.
Authorizes all appropriate services based on covered benefits and necessity of care provided.
Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate.
Coordinates the patient’s care with other health care personnel to ensure timely post-discharge care.
Secures outpatient follow-up appointments and scheduling tests or outpatient procedures with the appropriate providers.
Refers to Ambulatory Case Manager patients identified who will need oversight of outpatient care and to avoid unnecessary readmissions.
Coordinates referrals and secures appointments with various CSMNS disease management programs.
Enters and updates all authorization and clinical information into Nautilus (Access Express) no later than date of discharge.
Communicates with CSMPN Medical Director, Employee Health Services, Risk Management, and TPA.
Attends CSMPN clinical team meetings and reports high risk/high cost cases.
Advises timely and accurate reporting to the TPL carrier of all injured worker cases receiving case management services.
Ensures appropriate utilization of medical services within workers’ compensation benefits and/or utilization decisions, including movement of the patient through levels of care.
Qualifications
Education: Graduation from an accredited school of nursing required; Bachelor of Science in Nursing required.
License/Certifications: Valid CA RN license required; Certified Case Management preferred or willing to obtain within 2 years from start date.
Experience: 2 years in acute care nursing (Medical Surgical/Tele/ICU/LTACH) or 1 year in acute care nursing with 2+ years in care management (UM or discharge planning); 1 year of case management experience in acute inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules; knowledge of Epic preferred.
Cedars-Sinai is an EEO employer and prohibits discrimination on the basis of race, religion, color, national origin, citizenship, disability, medical condition, marital status, sex, gender, sexual orientation, gender identity, pregnancy, age, military/veteran status, or other protected status. Reasonable accommodations available via Applicant_Accommodation@cshs.org upon request. Cedars-Sinai will consider qualified applicants with criminal histories in accordance with the Los Angeles Fair Chance Initiative for Hiring.
Job Details
Req ID : 12507
Working Title : RN Care Coordinator - Inpatient Specialty Program - 8-Hour Days - $5,000 Hiring Incentive!!
Department : Case Management
Business Entity : Cedars-Sinai Medical Center
Job Category : Patient Services
Job Specialty : RN
Overtime Status : NONEXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $55.11 - $88.18
Location: Beverly Hills, CA
Note: This listing reflects the role as part of Cedars-Sinai’s ongoing hiring needs and is not intended to be an exhaustive description of all duties and responsibilities.