The dedicated staff, highly-skilled physicians and surgeons, and advanced technology combine to make working at Los Alamitos Medical Center a personally-rewarding work environment. Nursing staff often hold advanced degrees, are dedicated to caring for others in both their personal and professional lives, and work side-by-side with talented colleagues and medical staff. The hospital has an advanced bi-plane catheterization lab, robot-assisted surgery capabilities, an Orthopedic Destination Center, and the radiation oncology physician services are provided by UCLA Health. Outpatient services are provided in a colorful patient setting in our Total Care Pavilion and there will soon be nurse navigators to assist orthopedic and cancer patients. The hospital�s quality indicators reflect the hard work of physicians and staff. LAMC awards and distinctions include an A on the Leapfrog Hospital Safety Score, American Heart Association Get with the Guidelines Gold+ Performance Achievement Award for Heart Failure, American Stroke Association Get With the Guidelines Gold+ Performance Achievement Award for Stroke, American Stroke Association Target Stroke Honor Roll, and is a Joint Commission Advanced Primary Stroke Center. Los Alamitos Medical Center is a great place to work. There are more than 150 staff members who have been here over 20 years and the hospital has been in the community for nearly 50 years treating generations of families.

Summary

The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient�s resources and right to self-determination.

The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions.

This position integrates national standards for case management scope of services including:

Utilization Management supporting medical necessity and denial prevention

Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction

Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care

Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy

Education provided to physicians, patients, families and caregivers

Responsibilities

The individual�s responsibilities include the following activities:

Accurate medical necessity screening and submission for Physician Advisor review,

Care coordination,

Transition planning assessment and reassessment,

Implementation or oversight of implementation of the transition plan,

Leading and facilitating multi-disciplinary patient care conferences,

Managing concurrent disputes,

Making appropriate referrals to other departments, h) identifying and referring complex patients to Social Work Services,

Communicating with patients and families about the plan of care,

Collaborating with physicians, office staff and ancillary departments,

Leading and facilitating Complex Case Review,

Assuring patient education is completed to support post-acute needs,

Timely complete and concise documentation in Case Management system, n) maintenance of accurate patient demographic and insurance information,

Identification and documentation of potentially avoidable days,

Identification and reporting over and underutilization,

And other duties as assigned

Education

Preferred: Bachelor of Science in Nursing (BSN)

Experience

Required: Two (2) years acute hospital patient care experience.
Preferred: Acute hospital case management experience.

Certifications

Required: Active Registered Nurse license.
Preferred: Accredited Case Manager (ACM)

Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.