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Posted: 26-May-25
Location: Downey, California
Categories:
Internal Number: 24266
The RN ED Access Case Manager provides care coordination which emphasizes positive partnerships with nursing, physicians, and other key disciplines in order to coordinate admissions, transfers and repatriation to PIH Health Hospitals through the emergency room or direct admission. The RN ED Access Case Manager works closely with insurance and various payor to coordinate and assist with repatriation/transfer of out-of-network patients from PIH Health Hospitals to the patient’s contracted facility. The RN ED Access Case Manager performs utilization review with a high level of expertise by using criteria that demonstrates medical necessity to achieve authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, Outpatient). RN ED Access Case Manager also provides oversight of hospital bed control system and work in collaboration with House Supervisor to ensure appropriate placement of patients to the right level of care. The RN ED Access Case Manager works to ensure appropriate utilization of hospital resources in all settings and levels of care. The RN ED Access Case Manager is also responsible for completing discharge orders of patients discharge from the emergency department. Works closely with Care Management Coordinators in arranging delivery of DMEs, post emergency visit care including but not limited to coordinating discharges to SNFs, Subacutes, LTACs, Hospice, Home with and without home health services, or arranging various follow up appointments. Communicates effectively with patients, families, and other healthcare teams as necessary about various care coordination of patients in the emergency department of PIH Heath Hospitals.
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services.
The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
- Excellent verbal, written and organizational skills required
- Is organized and able to prioritize and delegate work appropriately
- Ability to work in fast-paced environment
- Highly developed ability to multitask with aptitude to pay close attention to details and maintain focus
- Ability to follow chain of command
- Knowledge of medical terminology and current third-party payor reimbursement methodologies
- Self-motivated and results oriented
- Proactive, can-do approach and desire to build positive working relationships through collaborative problem-solving
- Must be able to demonstrate sound decision-making and prioritization of skills
- Basic computer skills: Word, Excel, PowerPoint, Outlook. Able to utilize multiple electronic systems. Type 50 WPM
- Knowledge of hospital operations especially from an ER, ICU, nursing unit, environmental services and financial perspective
- Utilizes the approved process to resolve biophysical, psychological, educational, and environmental needs of patient/significant others when administering or explaining care
- Organized and can priority workload effectively and efficiently.
- Maintain an active California RN License
- Minimum of five (5) years of acute hospital nursing experience
Preferred:
- CCM or ACM (Certified Case Manager, Accredited Case Manager)
- BSN
- Minimum of one (1) year acute hospital nursing experience in Critical Care or Emergency Department
- Previous experience in case management.
- Knowledge of payer requirements and previous experience in case management or bed control.
Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V
