Lead, RN Case Manager, Full time, Days

The Lead, RN Case Manager is an experienced RN Case Manager who provides clinical and operational support to the Care Management leadership team. In addition to performing the full scope of an RN Case Manager, the Lead is responsible for supporting department operations, conducting audits, reinforcing regulatory compliance, leading assigned performance improvement projects, and ensuring standardization and quality in utilization review, care coordination, and discharge planning. Provides real-time guidance to team members, supports onboarding and competency development, leads quality and documentation audits, participates in throughput initiatives, and assists in implementing workflows and education to support safe and timely transitions of care. Manages the Student Internship and Preceptor Program for RN case management students, serving as liaison to academic partners and coordinating onboarding, preceptor assignments, and ongoing education.

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.

Required Skills

• Demonstrated ability to provide consultation and instruction to staff regarding their assessment, intervention, planning and evaluation of cases.

• Contributes to staff performance annual evaluation, performs staff annual competencies evaluations, provides staff orientation and training.

• Strong working knowledge of CMS Conditions of Participation for Discharge Planning and Utilization Review, InterQual/MCG criteria, payer requirements, and hospital policies.

• Knowledge with regulatory agency requirements, policies, and protocols.

• Demonstrate leadership and organizational skills.

• Independent performer and manages multiple assignments in a fast-paced environment.

• Strong critical thinking and problem-solving skills to identify and resolve problems and or escalate barriers to support throughput.

• Excellent communication and writing skills

Required Experience

• Current California license as current California RN license

• Bachelor’s degree of Science in Nursing

• 3 or more years of work experience as a case manager in hospital inpatient healthcare setting

• Evidence of continuing education and obtain ACM (Accredited Case Manager) within 3 years of hire.

Address
12401 Washington Blvd.

Salary
57.04-94.11

Shift
Days

Zip Code
90602

Share this job

Related Jobs

Director of Nursing

Full-time

1 week ago

Director of Nursing

Ocean Park Healthcare Center Santa Monica, CA

Join the Ocean Park Healthcare Center Team! We Are Hiring a Director of Nursing! Ocean Park Healthcare Center is a 41-bed skilled nursing facility with a secured/locked unit located in the heart of Santa Monica . Our team is committed to delivering high-quality, compassionate care to a unique and complex resident population. We are seeking a strong, hands-on Director of Nursing (DON) to lead our clinical team and ensure excellence in patient care, regulatory compliance, and staff development. The position of Director of Nursing reports to the Administrator. Benefits: Competitive salary (based on experience) Eligible for full-time benefits including: Health Dental Vision 401k Schedule: Full-Time Monday – Friday (with flexibility based on facility needs) On-call responsibilities required JOB DUTIES: Plan, organize, develop, and direct the overall operations of the Nursing Department Ensure compliance with all federal, state, and local regulations, including Title 22 and CMS guidelines Oversee and support nursing staff, including hiring, training, scheduling, and performance management Collaborate with the interdisciplinary team to ensure quality resident care and outcomes Monitor clinical systems including infection control, wound care, medication management, and documentation compliance Lead and participate in QAPI programs and quality improvement initiatives Ensure appropriate staffing levels and efficient labor management Serve as a clinical resource and leader within the facility DUTIES CONTINUED: Oversee care planning process and ensure individualized resident care plans are implemented and updated Maintain survey readiness at all times and lead the facility through state and federal surveys Investigate incidents, complaints, and grievances, ensuring timely resolution and documentation Support admissions process including clinical review and acceptance decisions Provide ongoing education, mentorship, and support to nursing staff Collaborate closely with the Administrator on operational and clinical goals Qualifications: Active California RN license in good standing Minimum 2+ years of nursing leadership experience in a skilled nursing facility required Strong knowledge of Title 22 regulations and CMS guidelines Experience in a secured/locked unit or behavioral health setting preferred Proven ability to lead teams, manage change, and drive clinical outcomes Excellent communication, leadership, and organizational skills Experience with electronic medical records (PCC preferred) Ability to maintain professionalism and composure in a fast-paced environment

MDS

Full-time

1 week ago

MDS Coordinator

Ocean Park Healthcare Center Santa Monica, CA

We are seeking a superhero in MDS to take the lead in Santa Monica, CA! Here are the benefits we offer: Healthcare coverage Dental benefits Vision care 401k plan Paid vacation days Consistent Monday to Friday work schedule Reporting to the Director of Nursing Services, the MDS Coordinator coordinates the Interdisciplinary Team (IDT) for MDS assessment completion to comply with State and Federal regulations. Key Responsibilities: Organize the Medicare/MDS resident assessment process. Ensure timely completion of MDS assessments by the Interdisciplinary Team Coordinate the development, implementation, and evaluation of care plans Administer prescribed treatments, medications, and nursing interventions Provide necessary nursing care while adhering to infection control standards Follow safety protocols during nursing care procedures Initiate emergency measures following center policy and nursing standards Facilitate the exchange of crucial information for quality resident care Maintain all required documentation as per Federal and state regulations, and Company policies Attend and contribute to all assigned meetings and training sessions Portray professionalism through attire, conduct, and communication with consumers Adhere to Company standards in addressing consumer inquiries MDS experience is a MUST! LVN or RN license is okay. This is a full-time role, Monday to Friday

Full-time

1 month ago

Nurse Case Manager - Urology

UCLA Health Los Angeles, CA

$1 - $1,000,000 / year

Description The Clinical Operations Lead/Nurse Case Manager for the IMPACT Program provides clinical and administrative leadership for a statewide prostate cancer treatment initiative. This role oversees clinical operations, supervises staff, and ensures compliance with state contract requirements. Responsibilities include managing clinical protocols, monitoring treatment utilization, coordinating care with more than 700 providers, and maintaining high-quality patient support and documentation. As the program's clinical expert and primary Case Manager, the incumbent conducts medical and social assessments, evaluates patient progress, provides patient and family education, and ensures consistent follow-up and quality assurance. This position plays a key role in supporting vulnerable patients and ensuring efficient statewide clinical operations. Annual salary range: $76,200.00 - $157,800.00

Per Diem

1 month ago

Per Diem RN - Perinatal

UCLA Health Los Angeles, CA

$1 - $1,000,000 / year

Description Become a key member of a world-class health organization. Contribute to the delivery of Magnet® designated nursing excellence. Take your career to the next level. Ucan do all this and more at UCLA Health. In this exciting and rewarding position, you will provide exceptional nursing care for Perinatal patients. You will offer guidance to team members by supervising nursing interventions, assigning related tasks, and managing complex patient care coordination. You will also assess patient, family and staff learning needs, deliver appropriate clinical education and promote effective working relationships. This involves collaborating with an interdisciplinary team of dedicated professionals to develop and implement a care plan, including providing detailed care instructions. The expectation is to float between Ronald Reagan (RR) UCLA and Santa Monica (SM) UCLA L&D and couplet care units as censes needs require with main responsibility to RRUCLA Perinatal Units. Salary Range: $96.74 - $96.74 hourly *This position may convert to career.

Med-Surg

Full-time

2 days ago

Registered Nurse (RN) – Med Surg – Berkeley Hospital

Roper St. Francis Healthcare Los Angeles, CA

Thank you for considering a career at Roper St. Francis Healthcare! Scheduled Weekly Hours: 36 Work Shift: Evenings/Nights (United States of America) Full-time Night Shift: 7pm - 7am Summary of Primary Function Delivers patient care utilizing the nursing process through data collection and assessment, identifies and determines the priority of patient’s problems/needs, and evaluates the process and outcome of nursing care; coordinates, provides and directs patient teaching activities and coordinates the care provided by health team members. Essential Job Functions In collaboration with the interdisciplinary care team, conducts initial and ongoing patient assessment, analyzes assessment data, creates a plan of care, implements treatment and evaluates treatment effectiveness; administers medications in a safe manner consistent with the State of Practice and organization policies and procedures; serves as point of contact for patients' care coordination throughout hospital departments. Acts as a patient safety advocate by participating in ongoing quality improvement in the department. Incorporates the professional practice model into care delivery Skills • Knowledge of contemporary nursing practice and future innovations • Nursing judgment and skill based on principles of the biological, physical, behavioral, and social sciences • Application of the nursing process in patient care delivery • Coordination of patient care delivery • Evaluation of professional nursing practice to optimize goals and outcomes • Health teaching and health promotion • Patient advocacy and partnership • Interprofessional collaboration and leadership • Understanding and utilization of office and clinical technologies • Compassionate, relationship-based approach to help find meaning in illness, suffering, pain, and existence • Integration of quality improvement, evidence based practices and research in practice • Accountability for professional actions • Effective stewardship of available resources • Conflict management and resilience • Authority for delegating activities to others, while remaining responsible and accountable for outcomes Certifications BLS Basic Life Support, American Heart Association (required at hire for Roper St Francis Healthcare locations; preferred at hire, required prior to independent patient care at BSMH) Valid nursing license from the state of practice (required) Education Associate of Nursing, nursing (required) OR Diploma in Nursing (required) Bachelors of Science, nursing (preferred) Roper St. Francis Healthcare is an equal opportunity employer. As a Roper St. Francis Healthcare teammate, you’re part of a Misson that matters. We support your well-being – personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way. What we offer Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible) Medical, dental, vision, prescription coverage, HAS/FSA options, life insurance, mental health resources and discounts Paid time off, parental and FMLA leave, and short- and long-term disability Tuition assistance, professional development and continuing education support Benefits may vary based on the market and employment status. Department: Combined Medical Surgical Unit - 3MedSurg - Berkeley Hospital It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, all applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@RSFH.com .