Lead, RN Case Manager, Full time, Days
About The Position
The Lead, RN Case Manager is an experienced RN Case Manager who provides clinical and operational support to the Care Management leadership team. In addition to performing the full scope of an RN Case Manager, the Lead is responsible for supporting department operations, conducting audits, reinforcing regulatory compliance, leading assigned performance improvement projects, and ensuring standardization and quality in utilization review, care coordination, and discharge planning. Provides real-time guidance to team members, supports onboarding and competency development, leads quality and documentation audits, participates in throughput initiatives, and assists in implementing workflows and education to support safe and timely transitions of care. Manages the Student Internship and Preceptor Program for RN case management students, serving as liaison to academic partners and coordinating onboarding, preceptor assignments, and ongoing education. 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.
Requirements
- Demonstrated ability to provide consultation and instruction to staff regarding their assessment, intervention, planning and evaluation of cases.
- Contributes to staff performance annual evaluation, performs staff annual competencies evaluations, provides staff orientation and training.
- Strong working knowledge of CMS Conditions of Participation for Discharge Planning and Utilization Review, InterQual/MCG criteria, payer requirements, and hospital policies.
- Knowledge with regulatory agency requirements, policies, and protocols.
- Demonstrate leadership and organizational skills.
- Independent performer and manages multiple assignments in a fast-paced environment.
- Strong critical thinking and problem-solving skills to identify and resolve problems and or escalate barriers to support throughput.
- Excellent communication and writing skills
Responsibilities
- supporting department operations
- conducting audits
- reinforcing regulatory compliance
- leading assigned performance improvement projects
- ensuring standardization and quality in utilization review, care coordination, and discharge planning
- Provides real-time guidance to team members
- supports onboarding and competency development
- leads quality and documentation audits
- participates in throughput initiatives
- assists in implementing workflows and education to support safe and timely transitions of care
- Manages the Student Internship and Preceptor Program for RN case management students, serving as liaison to academic partners and coordinating onboarding, preceptor assignments, and ongoing education
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
