RN Outpatient Full-time
PIH Health

Ambulatory Case Manager, RN, Full-Time, Days

apartment PIH Health location_onWhittier, CA 90601, US
Apply Now

The Ambulatory Case Manager, RN is responsible for providing comprehensive care coordination and case management services to members, ensuring seamless transitions of care, promoting health stabilization, and reducing avoidable hospitalizations. The PHP Ambulatory Case Management team is responsible for High-Risk Case Management, Complex Case Management (CCM), Special Needs Plan Case Management (SNP) and Care Coordination including Transitions of Care. This role requires strong knowledge of case management programs, health plan benefits, managed care principles, and community resources. Will engage with members, families, healthcare providers, and multidisciplinary teams to create and implement individualized care plans. Serves as a liaison between key stakeholders including members, providers, and health plans.

 

PIH Health is a nonprofit, regional healthcare network that serves approximately 3.7 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, 35 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

  • Strong knowledge of case management principles, care coordination, and transition of care processes
  • Understanding of managed care, including risk-based contracts, delegated health plans, and compliance requirements
  • Ability to work collaboratively with multidisciplinary teams, patients, and families
  • Strong communication, organizational, and problem-solving skills
  • Computer literate, with ability to navigate multiple computer applications 

Required Experience

 

  • Associate degree
  • Current California State RN licensure
  • Minimum 2 years clinical experience

 

Preferred:

  • Bachelor’s Degree
  • Valid California Driver’s License and proof of automobile insurance
  • Experience in case management.
  • Managed Care experience
  • Proficiency in Word and Excel

Address
6557 Greenleaf Ave.

Salary
55.00-70.50

Shift
Days

Zip Code
90601

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Director of Nursing Full-time
Ocean Park Healthcare Center

Director of Nursing

apartment Ocean Park Healthcare Center location_onSanta Monica, CA
What We’re Looking For: We’re looking for a dynamic Director of Nursing to lead our clinical team and provide our residents with an exceptional care experience. We need you to plan, organize, develop and direct the overall operation of your Nursing Service Department in accordance with current federal, state, and local standards, guidelines and regulations. Salary is based on experience. What You Will Do: Interview, hire, and train employees; plan, assign, and direct work; appraise performance; reward and discipline employees; address complaints and resolve problems Coordinate care and services to improve organization and implementation of plans of care, and quality of life and for all residents. Ensure proper assessment of all prospective residents prior to admission including visiting client at their home or in the hospital. Develop staffing plans that assure sufficient staffing to meet direct care needs, recommend numbers and types of nursing personnel necessary to provide care and maintain compliance Ensure 24hour availability as nursing administration resource by providing on-call and telephone access or designating an alternative, qualified nursing staff member to do so. Audit clinical records for accuracy and completeness of comprehensive resident assessments, effective documentation reflecting resident responses to interventions and consistent implementation of plans of care by all staff and professionals, on all shifts. Conduct quality assessment and assurance activities, including regulatory compliance rounds, in all departments to monitor performance and to continuously improve quality Lead and participate in interdisciplinary conferences as needed to develop adequate plans of care. Establish and maintain established policies, procedures, CQI programs and safety, environmental and infection control standards. Provide direct administrative and technical supervision of nursing, admissions and continuing care functions. Establish performance goals. Provide leadership in planning, organization, evaluation and fiscal management Collaborate with executive management team on Goals of our home Collaborate with interdisciplinary team members to develop and promote programs to enhance the resident’s quality of life and healthcare Ensure compliance with applicable local, state and federal regulations and the policies and procedures. Assist in the preparation of departmental budgets and allocation of funds based upon a review of department estimates and recommendations. What You’ll Bring: 2 years of DON experience in a California Skilled Nursing Facility preferred. Unrestricted RN license in the state of California Must be able to pass background check
RN Manager/Supervisor Utilization Review Full-time
UCLA Health

Utilization Management Manager, Medicare Advantage - RN

apartment UCLA Health location_onLos Angeles, CA
$1 - $1,000,000 / YEAR
Description Take on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you’ll provide direct management to a team of UM coordinators and nurses. You’ll work closely with Medicare Advantage leadership to plan, execute, and manage various initiatives related to UM administrative, operational, and strategic objectives. You’ll demonstrate leadership and effective communication by fostering collaborative relationships with peers, co-workers, and staff. You’ll be responsible for overseeing and coordinating the following major functions: Pre-service Authorizations/Denial Letters Concurrent Review Continuity of Care Retro Claims Retrospective Review Referral Automation Business Rules/Configuration Salary Range: $112,900 - $256,900 Annually
RN ER Med-Surg Telemetry Full-time
UCLA Health

RN - Med Surg/ Telemetry- Emergency Care Unit (Overflow)- Westwood

apartment UCLA Health location_onLos Angeles, CA
$1 - $1,000,000 / YEAR
Description Become a key member of a world-class health organization and contribute to the delivery of Magnet® designated nursing excellence. Take your career to the next level. U can do all this and more at UCLA Health! In this exciting and rewarding position, you will provide evidence-based inpatient medical, surgical, telemetry, and stepdown level of care to patients admitted to the hospital from the Emergency Department (ED). You will care for the admitted patients in the dynamic, fast-paced, high-patient turnover environment of the Emergency Department all while advancing the inpatient plan of care in coordination with the admitting team, case management and ED Charge Nurse. The Emergency Care Unit (ECU) overflow nurse will also assess patient, family and staff learning needs, deliver appropriate clinical education and promote effective working relationships. This involves collaborating with an interdisciplinary team of dedicated professionals to develop and implement a care plan, including providing detailed care instructions. Join our team today! Salary range: $65.76 - $97.76 Hourly
RN Full-time
UCLA Health

Transplant Nurse Coordinator-Autologous, CAR-T, and TIL Therapy Team

apartment UCLA Health location_onLos Angeles, CA
$1 - $1,000,000 / YEAR
Description The RN Transplant Coordinator is an integral member of UCLA Health’s Transplant and Cellular Therapy Program and is responsible for comprehensive care coordination for oncology patients undergoing Autologous stem cell transplantation, as well as CAR-T and Tumor Infiltrating Lymphocyte (TIL) therapies. This role collaborates closely with a team of six Adult and Pediatric RN Coordinators, including those supporting Allogeneic transplantation and Gene Therapies. This is a highly specialized and complex position that requires prior experience in Bone Marrow Transplantation and/or Cellular Therapy. The RN Transplant Coordinator oversees and coordinates all aspects of the pre-transplant and cellular therapy work-up process, including lab testing, diagnostic imaging, biopsies, and other required evaluations. Key responsibilities also include placing and tracking referrals, providing comprehensive education to patients and caregivers regarding the transplant and cellular therapy process, connecting patients with appropriate resources and proactively identifying and addressing barriers to care. While this role requires a high degree of autonomy and clinical expertise, the RN Transplant Coordinator is supported by a collaborative, multidisciplinary team that includes Physicians, Nurse Practitioners, Pharmacists, dedicated Insurance Coordinators and Financial Counselors, and fellow Nurses – all who are united in advancing cutting-edge cellular therapies and optimizing patient outcomes. This is a close-knit, mission-driven team, and we are seeking a flexible, motivated, and compassionate nurse who thrives in a collaborative, fast-paced environment and is committed to delivering exceptional patient-centered care. Salary range: $171,905-$231,099 (annually)
RN Manager/Supervisor Full-time
UCLA Health

RN Supervisor - Immediate Care, Westwood

apartment UCLA Health location_onLos Angeles, CA
$1 - $1,000,000 / YEAR
Description In this role you will be responsible for all nursing and clinical services, provides direct nursing care, clinical administration, patient flow coordination, supervision of clinic nursing staff, infusion therapy and documentation of care in the Westwood Immediate Care. Major functions include: Triage of patients, patient assessment, patient evaluation for both adult and pediatric patient populations. Coordination and assignment of tasks and duties. Supervision of clinical staff ensuring all applicable policies and standards are maintained. Planning for and adjusting staffing on a daily basis to maintain efficient and adequate operations. Participation in annual performance evaluations. Maintaining yearly staff competencies. Providing necessary training for new and existing staff. Manage Quality Assurance process. Review and approve staff timesheets. Preparation and administration of intravenous drugs and fluids, immunizations, patient education and psychosocial support. Act as a resource to other licensed and unlicensed staff members. Salary Range: $128,500 - $298,100/annually