RN, Case Manager Per Diem
Posted on: June 18, 2022
OVERVIEW OF POSITION:HealthCare Partners, A DaVita Medical Group
is seeking a per diem registered nurse to support our inpatient
case management team in Torrance, CA.Primarily seeking a RN who can
work weekend shifts. About 1-2+ per month.Responsible for ensuring
the continuity of care in both the inpatient and outpatient setting
utilizing the appropriate resources within the parameters of
established contracts and patients' health plan benefits.
Facilitates continuum of patients' care utilizing advanced nursing
knowledge, experience and skills to ensure appropriate utilization
of resources and patient quality outcomes. Performs care management
functions on-site or telephonically as the need arises. Reports
finding to the Care Management department Manager in a timely
- Implements and monitors current medical group care management
programs within the policies and procedures set by the Care
- Conducts on-site or telephonic prospective, concurrent and
retrospective review of active patient care, including out-of-area
- Reviews patients' clinical records of acute inpatient within 24
hours of notification.
- Reviews patients' clinical records within 48 hours of SNF
- Reviews patient referrals within the specified care management
- Coordinates treatment plans and discharge expectations and
discusses DPA and DNR status with attending physician.
- Prioritizes patient care needs and meets with patients,
patients' family and caregivers as needed to discuss care and
- Identifies and assists with the follow-up of high-risk patients
in acute care settings, skilled nursing facilities, custodial and
- Consults with physician and other team members to ensure that
care plan is successfully implemented.
- Coordinates provisions for discharge from facilities including
follow-up appointments, home health, social services,
transportation, etc., in order to maintain continuity of care.
- Communicates authorization or denial of services to appropriate
parties. Communication may include patient, attending/referring
physician, facility administration and claims as necessary.
- Participates actively in assigned Care Management Committee
meetings. Documents pertinent patient information, all
communication and decisions.
- Demonstrates a thorough understanding of the cost consequences
resulting from care management decisions through utilization of
appropriate reports such as Health Plan Eligibility and Benefits,
Division of Responsibility (DOR) and Bed Days.
- Ensures appropriate utilization of medical facilities and
services within the parameters of the patients' benefits and/or CMC
decisions. This includes appropriate and timely movement of
patients through the various levels of care.
- Maintains effective communication with the health plans,
physicians, hospitals, extended care facilities, patients and
- Provides accurate information to patients and families
regarding HMO benefits, community resources, referrals and other
- Initiates and oversees data entry into IS systems of all
patients within the parameters of care management policies and
- Maintains accurate and complete documentation of care rendered
including LOC, CPT code, ICD-9, referral type and date.
- Follows patients on ambulatory care management programs,
including CHF and home health in order to optimize clinical
- Uses, protects, and discloses patients' protected health
information only in accordance with Health Insurance Portability
and Accountability Act (HIPAA) standards.
- Performs additional duties as assigned.EDUCATION:
- Bachelor's degree from a four-year college and/or a
professional certification requiring formal education beyond a
two-year college or equivalent experience.
- Graduation from an accredited school of Nursing.
- California RN license.
- Bachelor's degree in Nursing preferred.
- Basic Life Support for Healthcare providers (AHA) or CPR/AED
for the Professional Rescuer (American Red
- Over 3 years and up to and including 5 years of
- At least 1 year of recent clinical experience.Preferred:
- 3 to 5 years of acute nursing experience in critical care.
- Previous care management, utilization review or discharge
- HMO experience.KNOWLEDGE, SKILLS, ABILITIES:
- Knowledge of current standards of patient care.
- Thorough understanding of RN scope of practice.
- Manual dexterity to use/handle equipment and instruments.
- Ability to effectively communicate and collaborate with
physicians, patients, families and ancillary staff.
- Ability to make sound, independent judgments and act
professionally under pressure.UnitedHealth Group requires all new
hires and employees to report their COVID-19 vaccination status
- COVID-19 Work Location Requirement: You will be provisioned
with appropriate Personal Protective Equipment (PPE) and are
required to perform this role with patients and members on site, as
this is an essential function of this role.Careers with Optum.
Here's the idea. We built an entire organization around one giant
objective; make health care work better for everyone. Optum, part
of the UnitedHealth Group family of businesses, brings together
some of the greatest minds and most advanced ideas on where health
care has to go in order to reach its fullest potential. For you,
that means working on high performance teams against sophisticated
challenges that matter. Here you'll find incredible ideas in one
incredible company and a singular opportunity to do your life's
best work.Diversity creates a healthier atmosphere: Optum and its
affiliated medical practices are Equal Employment
Opportunity/Affirmative Action employers and all qualified
applicants will receive consideration for employment without regard
to race, color, religion, sex, age, national origin, protected
veteran status, disability status, sexual orientation, gender
identity or expression, marital status, genetic information, or any
other characteristic protected by law. Optum and its affiliated
medical practices is a drug-free workplace. Candidates are required
to pass a drug test before beginning employment.
Keywords: Optum, Torrance , RN, Case Manager Per Diem, Healthcare , Torrance, California
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