Providence is calling a Registered Nurse Case Manager - Utilization Care Management Office (Full Time/Variable shift) to Providence Little Company of Mary Medical Center in San Pedro, CA.
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We are seeking a Registered Nurse Case Manager - Utilization Care Management Office who will perform the primary functions of assessment, planning, facilitation and advocacy, which are achieved through collaboration with the client and other health care professionals involved in the client's care.
In this position you will:
- Establish priorities
- Consider evidenced-based protocols for new patients
- Keep running problem sheet on the patient, so hand-offs are easy
- Diagnostics to be reviewed or ordered
- Interactions with sub-specialists
- Consult requests
- Post-acute options and confirmation of targeted transition
- Accuracy and completeness of medical documentation
- Start the discharge planning on admission to evaluate probable post-acute needs and target a transition date
- Care Management:
- Responsible for established Ministry and Regional metrics. Monitoring specific CM/SW outcomes. Participates in regional and system directives
- Conduct a comprehensive assessment of the client’s health and psychosocial needs, including health literacy status and deficits, and develops a case management plan collaboratively with the client and family or caregiver
- Plan with the client, family or caregiver, the primary care physician/ provider, other health care providers, the payer, and the community, to maximize health care responses, quality, and cost effective outcomes
- Facilitate communication and coordination between members of the health care team, involving the client in the decision-making process in order to minimize fragmentation in the services
- Educate the client, the family or caregiver, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, case management, etc., so that timely and informed decisions can be made
- Empower the client to problem-solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes
- Encourage the appropriate use of health care services and strives to improve quality of care and maintain cost effectiveness on a case-by-case basis
- Assist the client in the safe transitioning of care to the next most appropriate level
- Strive to promote client self-advocacy and self-determination
- Advocate for both the client and the payer to facilitate positive outcomes for the client, the health care team, and the payer. However, if a conflict arises, the needs of the client must be the priority
Required qualifications for this position include:
- Bachelor's degree
- Current California Registered Nurse ( RN ) license
- At least two years of acute hospital experience, including one year supervisory experience
- Special Skills/Desirable Qualifications:
- Must be tactful and proficient at conflict resolution
- Must be able to work well independently and with a team
- Judgment must include ability to make accurate, rapid and long-term decisions under pressure
- Must be able to project a positive self-image
- Must be self-motivated
- Must have good oral and written communication skills
- Strong leadership, supervision interpersonal and organizational skills
- Excellent communication skills, both oral and written
- Excellent customer services skills
- Strong problem-solving skills and flexibility
- Demonstrated ability to work independently and self-directed
- Ability to plan, organize, prioritize, evaluate and document
- Excellent presentation skills
- Basic computer skills, Word, Excel, Access and PowerPoint
- Knowledge regarding State and Federal regulations, HMO, PPO and Utilization processes
- Knowledge of Discharge planning and Case Management
- Knowledge of principles and practices of Utilization and Quality Management
- Knowledge of CPT, IDC-9 Coding
- Strong knowledge base or experience in specialty area assigned
Preferred qualifications for this position include:
- Master's degree in healthcare related field
About the hospital you will serve.
Providence Little Company of Mary Medical Center San Pedro is a 259-bed nonprofit hospital that has served the Harbor and greater South Bay communities since 1925. Our Medical Center offers a comprehensive array of medical and surgical services each distinguished by innovation, quality and excellence in its respective area. We received the CHART “Certificate of Excellence” for receiving superior or above average results across the majority of outcomes and process measures publicly reported by CHART. We ranked in the top 21 among more than 240 hospitals throughout the state compared by California Healthcare Foundation, and were the first location in the South Bay to carry the Gold Seal of Approval® from The Joint Commission for Primary Stroke Centers. As a member of Providence Health & Services, we are continually driven by the caring tradition of our heritage – the foundation of our Mission and core values – to embrace respect, compassion, justice, excellence and stewardship. Providence Health & Services today celebrates unprecedented growth, recognition for top quality health care, a vibrant employee culture where new ideas are encouraged and a drive to help the underprivileged - all with an eye toward the future.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Location: California-San Pedro
Req ID: 303110