Job Description

Cedars-Sinai has been named to the Honor Roll for the ninth consecutive year and tied for #1 in California and Los Angeles in U.S. News & World Report?s "Best Hospitals 2024-25" rankings, as well as placed among the very best in 11 specialties nationwide.

Align yourself with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation?s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded the Advisory Board Company?s Workplace of the Year. This recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. Join us! Discover why U.S. News & World Report has named us one of America?s Best Hospitals.

Why work here?

Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) we take pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation.

A Little More About What You Will be Doing

The Case Manager is responsible for the case management of patient while hospitalized and upon discharge from various care settings. In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the Case Manager will assist patients from the time they are admitted until they are discharged from the hospital by assessing their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered and to ensure that quality care is delivered in an efficient manner.

Job duties and responsibilities:

• Meets with patients within 24 hours of admission and conducts an initial assessment.
• Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patient?s stay.
• Reviews with hospitalist the patient?s admission and continued stay for medical necessity, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary.
• Collaborates with clinical teams and practices to ensure synchronization of sub-areas? operations to reach organizational and departmental goals. Reviews with hospitalist the patient?s admission and continued stay for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to match the payor
• Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy.
• Begins discharge planning and care assessment within one working day (preferably on day of admission).
• Submits necessary clinical information to the health plan using the accepted format (MIDAS or telephonic) and coordinate health plan communication with assigned hospitalist as appropriate.
• For patients who are transitioning to the Skilled Nursing Facilities, refers to nurse practitioner and case manager assigned to the SNF?s for continued review and follow up.
• Authorizes all appropriate services based upon covered benefits and necessity of care provided.
• Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate.
• Coordinates the patient?s care with other health care personnel to ensure that the patient receives care timely post discharge.
• Secures outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers.
• Refers to Ambulatory Case Manager patients identified that will need oversight of outpatient care and compliance to avoid unnecessary readmissions.
• Coordinates referrals and secure appointment with various CSMNS disease management programs.
• Enters and updates all authorization and clinical information into Nautilus (Access Express) no later than date of discharge.
• Communicates regularly with CSMPN Medical Director, Employee Health Services, Risk Management, and TPA
• Attends all CSMPN clinical team meetings, and report high risk/high cost cases.
• Directs timely and accurate reporting to the TPL carrier of all injured worker cases receiving case management services.
• Ensures appropriate utilization of medical services within the parameters of the workers compensation benefits and/or Utilization decisions. This includes appropriate movement of the patient through the various levels of care.

Qualifications

• Graduation from an accredited school of nursing required
• Bachelor of Science degree in Nursing required

• Valid CA RN license required
• BLS required from AHA or ARC
• Certified Case Management preferred or willing to obtain within 2 years time from start date

• 2 years in acute care nursing - Medical Surgical/Tele/ICU/LTACH or 1 year in acute care nursing (Medical Surgical/Tele/ICU) with 2 or more year of care management experience (UM or DC Planning).
• 1 year of previous experience in case management in the acute inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings preferred
• Knowledge of workers compensation rules and regulations is highly preferred
• Knowledge of Epic is highly preferred

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment.

About Cedars Sinai

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