The RN 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 PHDH through the emergency room or direct admission. The RN Access Case Manager works closely with insurance and various payor to coordinate and assist with reparation/transfer of out-of-network patients from PHWH to the patient’s contracted facilities. The RN 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 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 Access Case Manager works to ensure appropriate utilization of hospital resources in all settings and levels of care.

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 Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Excellent verbal and written communication skills

• Thorough knowledge of hospital operations especially from an ER, ICU, nursing unit, environmental
  services and financial perspective.

• Highly developed ability to multi-task and maintain focus

• Proactive, can-do approach and desire to build positive working relationships through collaborative
  problem-solving

• Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility
  and prioritization skills.

• Strong organizational skills

• Basic computer skills; Outlook, Word and Excel

Required Experience

Required:

• Maintain an active California RN License.
• Obtain ACM (Accredited Case Manager) or CCM (Certified Case Manager) within 3 years of hire.
• Minimum of five (5) years of acute hospital nursing experience.
• LA City Fire card within 6 months of employment (PHGSH only)

Preferred:

• CCM or ACM (Certified Case Manager, Accredited Case Manager)
• Minimum of one (4) year acute hospital nursing experience with ICU or ED background
• Previous experience in case management.
• Knowledge of payer requirements and previous experience in case management or bed control.

• Excellent verbal and written communication skills

• Thorough knowledge of hospital operations especially from an ER, ICU, nursing unit, environmental
  services and financial perspective.

• Highly developed ability to multi-task and maintain focus

• Proactive, can-do approach and desire to build positive working relationships through collaborative
  problem-solving

• Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility
  and prioritization skills.

• Strong organizational skills

• Basic computer skills; Outlook, Word and Excel