Job Information
Actalent RN Case Manager in Riverside, California
Job Title: RN Case Manager
Job Description
The RN Case Manager is responsible for providing comprehensive case management for patients in skilled nursing facilities. This role includes coordinating with SNF team members, nursing, rehab, discharge planning, dietary, admissions, directors of nursing, administrators, and physicians. Additionally, the position involves telephonic case management for the Special Needs Department (SNP) if needed.
Responsibilities
Conduct medical necessity screening and submit for Physician Advisor review.
Care coordination and implementation of transition plans based on RN Case Manager and/or Social Worker assessments.
Communicate with the interdisciplinary team during patient care conferences.
Manage concurrent disputes and communicate with patients and families regarding the plan of care.
Collaborate with physicians, office staff, and ancillary departments.
Document accurately and completely in the electronic system.
Maintain accurate patient demographic and insurance information.
Identify and document potentially avoidable days.
Identify and report over and underutilization of resources.
Ensure the patient is in the appropriate status and level of care based on medical necessity and submit for secondary physician review.
Advocate for the patient and hospital with payers to secure appropriate payment for services rendered.
Complete clinical reviews and promote prudent utilization of resources.
Identify appropriate level of care needs and assist with patient transition.
Clarify orders related to admission status and patient management.
Essential Skills
Registered Nurse (RN) license.
Experience in an acute hospital setting (200-300 bed hospital) as a floor nurse or in clinical care.
Discharge planning experience in a hospital setting.
Experience with HealthConnect or EPIC systems.
Additional Skills & Qualifications
Proficiency in Excel and data entry.
Clinical experience in a hospital setting.
Work Environment
This position operates Monday through Friday with rotating weekends (every other weekend). Standard hours are 8 am to 5 pm.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
Hiring diverse talent
Maintaining an inclusive environment through persistent self-reflection
Building a culture of care, engagement, and recognition with clear outcomes
Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.