Overview • Deliver exceptional case management for acute care patients, ensuring seamless transitions and optimal health outcomes. • Collaborate with interdisciplinary teams to design and implement personalized care plans addressing diverse patient needs. • Conduct comprehensive assessments to evaluate clinical, psychosocial, and financial aspects of patient care. • Ensure compliance with healthcare regulations and standards for patient care and transitions. • Facilitate effective communication among patients, families, and healthcare professionals to support care coordination. • Monitor patient progress and adjust care plans to achieve desired health outcomes. • Coordinate discharge planning by liaising with community health resources and providers. • Serve as a resource for staff and physicians regarding care management protocols and best practices. Key Responsibilities & Duties • Conduct timely admission reviews and assessments to establish effective care plans. • Collaborate with emergency department coordinators to ensure smooth patient transitions. • Develop and implement care plans addressing clinical milestones and patient goals. • Ensure efficient resource utilization and adherence to regulatory guidelines. • Educate physicians and staff on admission status and regulatory requirements. • Monitor clinical outcomes and address quality and efficiency concerns proactively. • Coordinate safe discharge plans and follow-up care for patients. • Maintain effective communication with interdisciplinary teams and patient families to ensure cohesive care delivery. Job Requirements • Bachelor of Science in Nursing (BSN) or Master’s degree in Nursing required. • Active California Registered Nurse (RN) licensure mandatory; Case Management certification preferred. • Minimum of two years of experience in acute care or case management settings. • Proficiency in utilizing medical necessity criteria, including Interqual guidelines. • Strong clinical and critical thinking skills to establish and execute complex care plans. • Knowledge of healthcare delivery systems and payer prior approval requirements. • Effective communication skills for interacting with patients, families, and healthcare teams. • Ability to analyze situations accurately and take effective action to resolve challenges.