Job Information
Rady Children's Hospital San Diego RN Case Manager - Case Management in San Diego, California
JOB SUMMARY:
Case Managers function as liaisons between patients, their families, and internal and external health care personnel to ensure appropriate, efficient, and timely health care service. Their focus includes providing clinical documentation to third party payers to facilitate authorization and reimbursement for inpatient hospital stays, coordinating discharge needs, and providing information to the Quality department for follow-up. The Case Manager advocates for the patient and family and collaborates with the health care team to facilitate appropriate movement along the continuum of care from inpatient admission to discharge.
Note: Case Managers perform concurrent review and denials management based on acute care guidelines with a focus on authorization and reimbursement, appropriateness of admission, length of stay, and avoidable delays in discharge. The Case Manager collaborates with the family, the care team, third party payors, and outside providers to coordinate discharge needs including home health, durable medical equipment, and safe transitions of care.
MINIMUM QUALIFICATIONS:
Bachelor's Degree in Nursing
Current California RN license
One year of pediatric experience
Competent in utilization of computers
Three years of experience
PREFERRED QUALIFICATIONS:
Four years of experience
Utilization review, case management, discharge planning experience
Bilingual English/Spanish
The current salary range for this position is $59.73 to $97.42
A candidate’s placement in the range will be determined based on the terms and conditions of the applicable collective bargaining agreement. Rady Children’s Hospital is committed to being externally competitive and internally equitable. We demonstrate this commitment by reviewing market data to remain competitive within the nonprofit, healthcare sector. This posting will remain open from the “date posted” until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.
EOE including disability/vet