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Supervisor, Case Management (RN)

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Requisition # HRC1092549

Make a difference every single day!

When the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters. This shared culture of compassion, teamwork, integrity and dedication pulses through Cedars-Sinai Marina Del Rey Hospital. Working with a team of world-class healthcare professionals you'll have everything you will need to do something incredible-for yourself, and for others. Join us, and support our community with the highest quality healthcare!

The Supervisor, Case Management  (RN) will provide staff supervision and hands on expertise to other team members as needed to help ensure that every patient receives the right type of care, at the right time in the right setting, every day. The Supervisor will oversee a manageable patient caseload and utilize medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, estimation of the patient's expected length of stay and securing insurance authorization for services provided. The Supervisor will follow the UR and/or Case Management process per department policy and as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review. The supervisor is responsible for day-to-day oversight of the department RN case managers and their workflows.

What you'll be doing in this role:

  • Leads patient case load and acts as a resource for the staff and Nurses regarding Utilization Management (UM) and/or Case Management department process and payer processes as needed. Acts as a first point of contact for clinical clarification/education. Supervises ability of team members to complete same work.
  • Works collaboratively with department leadership and staff to ensure that work processes are well-ordered and managed appropriately. Provide backup to staff, other departmental teams and/or management staff, as needed.
  • Supports and actively participate in department performance improvement, assist with the development, implementation and monitoring of processes and procedures to facilitate improvement.
  • Participates in monitoring and data analysis of utilization metrics.
  • Monitors of staff workload, creating assignments, reviewing productivity, conducting quality reviews, advising with peer-to-peer appeals, and advising with concurrent denials.
  • Reviews concurrent denials and works with the payer and physician to overturn the denial; Assists in arranging peer to peer conferences.
  • Monitors patient length of stay and collaborates with physicians, care coordinators and multidisciplinary team to ensure resource utilization is appropriate for patients’ overall needs.
  • Consults with medical staff, care team and care coordinators as necessary to resolve immediate progression of care barriers through appropriate administrative and medical channels.
  • Identifies and documents delays in service, progression of care or patient flow barriers using the Avoidable Days tool in the Utilization software program.
  • Processes confidential data and information according to appropriate organization and federal guidelines.
  • Maintains appropriate documentation in the Utilization software system on each patient as per the department “Medical Necessity and Clinical Review Process” department guidelines.
  • Functions as an advocate, and contact person for the care team, patient/family when communicating with payers, and or outside agencies to assure continuity of care, optimal clinical resource outcomes, and appropriate financial management for the patient and the organization.
  • Participates in development and leadership with departments continuing education.

 


Education Requirements:

  • Assoc. Degree in Nursing required
  • Bachelor's Degree in Nursing preferred

Licenses/Certifications:

  • California RN License required
  • Basic Life Support (BLS) required

Experience:

  • 3 years Acute Nursing experience required
  • 2 years Case Management experience required

Working Title:Supervisor, Case Management (RN)
Business Entity:Cedars-Sinai Marina del Rey Hospital
Job Category:Patient Services
Position Type:Full-time


Qualifications

Education Requirements:

  • Assoc. Degree in Nursing required
  • Bachelor's Degree in Nursing preferred

Licenses/Certifications:

  • California RN License required
  • Basic Life Support (BLS) required

Experience:

  • 3 years Acute Nursing experience required
  • 2 years Case Management experience required

Cedars-Sinai Marina del Rey Hospital is an EEO employer. Cedars-Sinai Marina del Rey Hospital does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

Cedars-Sinai Marina del Rey Hospital will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

At Cedars-Sinai Marina del Rey Hospital, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu) and COVID-19. For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a conditiosn of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines such as COVID-19 as a condition of employment. Cedars-Sinai Marina del Rey Hospital reserves the right to make modifications to its required list of vaccines as required by law and/or policy.

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  • Patient Services, Marina del Rey, California, United StatesRemove