The purpose of the Case Manager position is to support the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include: facilitation of pre-certification and payer authorization processes, facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement, application of process improvement methodologies in evaluating outcomes of care support and coaching of clinical documentation efforts and serving as a clinical resource for coders, ensuring that documentation accurately reflects severity of illness and intensity of service coordinating communication with physicians.
The purpose of the Case Manager position is to support the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include: facilitation of pre-certification and payer authorization processes, facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement, application of process improvement methodologies in evaluating outcomes of care support and coaching of clinical documentation efforts and serving as a clinical resource for coders, ensuring that documentation accurately reflects severity of illness and intensity of service coordinating communication with physicians.
JOB ACCOUNTABILITIES
• Actively participates in clinical performance improvement activities.
• Applies approved InterQual criteria to monitor appropriateness of admissions and continued stays and documents findings
based on department standards.
• Assist in the compilation of physician profile data regarding LOS, resource utilization, denied days, cost, case mix index,
patient satisfaction, and quality indicators.
Pay Transparency
The hourly rate range for this position is $46.00 - $76.07. When extending an offer of employment, the University of Southern California Arcadia Hospital considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, State, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
Minimum Education:
Associate’s Degree Nursing
Minimum Skills:
Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
Excellent interpersonal communication and negotiation skills.
Strong organizational and time management skills, as evidenced by a capacity to prioritize multiple tasks and role components.
Understanding of pre-acute and post-acute venues of care and post-acute community resources.
Strong analytical, data management, and PC skills.
Required Certifications:
Registered Nurse - RN (CA Board of Registered Nursing)
Basic Life Support (BLS) Healthcare Provider from American Heart Association
Preferred Experience:
3 years Clinical experience in Utilization Review and Discharge Planning in an Acute Hospital strongly preferred.
USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to theBackground Screening Policy Appendix D****https://policy.usc.edu/wp-content/uploads/2024/08/Background-Screening-Policy-Appendix-D-1.pdffor specific employment screen implications for the position for which you are applying.
We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at uschr@usc.edu. Inquiries will be treated as confidential to the extent permitted by law.
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