The RN Access Case Manager provides care coordination which emphasizes positive partnerships with nursing, physicians and other key disciplines in order to coordinate admissions, transfers and repatriation to PIH through the emergency room or direct admission. The RN Access Case Manager works closely with insurance and various payor to coordinate and assist with reparation/transfer of out-of-network patients from PIH to the patient’s contracted facilities. The RN Access Case Manager performs utilization review with a high level of expertise by using criteria that demonstrates medical necessity to achieve authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, Outpatient). RN Access Case Manager also provides oversight of hospital bed control system and work in collaboration with House Supervisor to ensure appropriate placement of patients to the right level of care. The RN Access Case Manager works to ensure appropriate utilization of hospital resources in all settings and levels of care.

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.

• Excellent verbal and written communication skills
• Thorough knowledge of hospital operations especially from an ER, ICU, nursing unit, environmental
  services and financial perspective.
• Highly developed ability to multi-task and maintain focus
• Proactive, can-do approach and desire to build positive working relationships through collaborative
  problem-solving
• Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility
  and prioritization skills.
• Strong organizational skills
• Basic computer skills; Outlook, Word and Excel

Required:

• Maintain an active California RN License.
• Obtain ACM (Accredited Case Manager) or CCM (Certified Case Manager) within 3 years of hire.
• Minimum of five (5) years of acute hospital nursing experience.
• LA City Fire card within 6 months of employment (PHGSH only) 

Preferred:

• CCM or ACM (Certified Case Manager, Accredited Case Manager)
• Minimum of one (4) year acute hospital nursing experience with ICU or ED background
• Previous experience in case management.
• Knowledge of payer requirements and previous experience in case management or bed control.

About PIH Health

PIH Health is the Communities’ Health and Wellness Partner Our network of highly trained and compassionate physicians, nurses, clinicians, staff and volunteers work tirelessly and collaboratively every day to maintain and enhance the health and wellbeing of every member of our service areas. And when needed, we are here to coordinate care, manage chronic disease, and treat health conditions for the best possible outcomes. We’re a nonprofit, regional healthcare network with three hospitals, numerous outpatient medical offices, 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. Our leadership is dedicated to putting patients first—a cornerstone of our mission, vision and values—as we deliver top-quality healthcare. We serve more than 3.7 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. Why PIH Health? Our culture is built around our core values, which are the guiding principles for everything we do. For over 60 years, PIH Health has maintained a sense of community and a family-like cultur...e where patients are the top priority, and employees and volunteers are proud to be affiliated with such an outstanding organization. PIH Health Hospital - Whittier Our Whittier campus delivers outstanding and compassionate care to patients, every day. Among other awards, PIH Health Hospital - Whittier has been named one of the nation’s 100 Top Hospitals® for the third consecutive year by Truven Health Analytics. PIH Health Hospital in Whittier, CA is located 30 minutes east of Los Angeles, close to the Los Angeles and Orange County border. There are many great communities in which to live that surround the hospital. This means easy access to work, great dining, shopping, entertainment and spectacular beaches. Whatever your passion, you’ll find the right place for it here. PIH Health Hospital - Downey is a nonprofit hospital with a rich, nearly 100-year history of meeting the healthcare needs of its community. The Downey campus is part of the PIH Health comprehensive health network consisting of two hospitals, 18 medical office locations and a host of specialty services. According to US News & World Report, the hospital scores highly in patient safety and orthopedics. With 955 employees, the hospital is the 5th largest employer in the city of Downey.

Show more

Show less

Connections working at PIH Health