Cedars-Sinai Case Manager in Los Angeles, California
Case Manager Requisition # M12132
Conducts case management on patients in the inpatient, intensive outpatient, residential care and Skilled Nursing Facility settings. CSMNS has developed a case management program that is geared towards the management of patients while hospitalized and upon discharge from various care settings. Using the Case Management Society of America’s (CMSA) model, we describe our approach as “a collaborative process of assessment, planning,
facilitation and advocacy for options and services to meet an individual's health needs
through communication and available resources to promote quality cost-effective outcomes.” In collaboration with the Inpatient Specialty Program (ISP) hospitalists (physicians who practice hospital medicine), the program is designed to assist patients from the time they are admitted until they are discharged from the hospital by assessing their needs, coordinating care, communicating with health plans (including concurrent review, which assists the hospitalist/specialist and case manager to determine the appropriateness of services rendered and to ensure that quality care is delivered in a cost-effective manner), and referring to disease management programs and ambulatory case management (focus is on those members requiring complex and/or chronic care for follow up after discharge). Decisions regarding care are made within one working day of obtaining all necessary information.
ESSENTIAL JOB DUTIES:
1) Care manager meets with patients within 24 hours of admission and conducts an initial
2) Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patient’s stay
a) Review with hospitalist the patient’s admission and continued stay for medical
necessity, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary.
b) Begin discharge planning and care assessment within one working day (preferably on day of admission).
3) Submit necessary clinical information to the health plan using the accepted format (MIDAS or
telephonic) and coordinate health plan communication with assigned hospitalist as appropriate.
4) For patients who are transitioning to the Skilled Nursing Facilities, refer to nurse practitioner
and case manager assigned to the SNF’s for continued review and follow up.
a) Physician will be notified of such a transition within 24 hours of admission to the
b) Transition of care will be communicated to the member or responsible party at least 1
day prior to the transition, which includes information pertaining to:
i) Transition process and what to expect
ii) Changes in health status and the care plan
iii) Staff who will be handling issues, questions, concerns, i.e. Case Manager,
Social Worker, Nurse Practitioner.
5) Case Manager will wear appropriate CSMNS employee badge: all rules and policies of
the facility will be followed while on-site.
6) If admission is to a non-contracted facility, determine if patient is stable for transport and transfer back in-network.
7) Authorize all appropriate services based upon covered benefits and necessity of care provided
a) Member’s home or residence
b) Acute Care
c) Skilled Nursing Facility
d) Rehabilitation Facility
e) Home Health Care
f) Custodial Care facility or Board and Care Facility
8) Coordinate discharge planning and alternative treatment plans with PCP/hospitalist/specialist
a) After hours, the on-call case manager support that is an invaluable resource to both
the patients and the physicians.
b) Coordinate the patient’s care with other health care personnel to ensure that the
patient receives care timely post discharge.
9) Secure outpatient follow-up appointments and scheduling tests or outpatient procedures with
appropriate health care providers
10) Referral to Ambulatory Case Manager for those patients identified that will need oversight of
outpatient care and compliance to avoid unnecessary readmissions
11) Coordinate referrals and secure appointment with various CSMNS disease management
programs such as anticoagulation clinic, Asthma, Diabetes, Hepatitis C, smoking
cessation, cardiovascular risk reduction and nutrition, as appropriate
12) Enter and update all authorization and clinical information into Nautilus (Access Express) no
later than date of discharge.
Education Certifications/Licensure Experience Physical Abilities Graduation from an accredited school of nursing; current California RN or LVN licensure; 3-5 years of acute nursing experience; knowledge of medical/nursing standards of care; ability to effectively communicate and collaborate with physicians, patients/families, and ancillary staff to make sound, independent judgments and to act professionally under pressure; 1-2 years of previous experience in case management in the acute inpatient or outpatient settings; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings.
Preferred candidates are Certified Case manager (CCM) certification for RN’s, utilization review (UR) experience, and minimum of BSN (Bachelor of Science degree in Nursing).
- Working Title: Case Manager
- Business Entity: MDN - Medical Delivery Network
- Cost Center # - Cost Center Name: 0861065 - MNS ISP
- City: Los Angeles
- Job Category: Allied Health/Clinical
- Job Specialty: Other Allied Health
- Position Type: Regular-F/T
- Shift Length: 8hr
- Hours: 8:00am - 5:00pm
- Days: Monday - Friday
- Shift Type: Day
- Weekends: As Needed
Cedars-Sinai is an EEO employer. Cedars-Sinai 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. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
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