The RN ED 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 Health Hospitals through the emergency room or direct admission. The

RN ED Access Case Manager works closely with insurance and various payor to coordinate and assist with repatriation/transfer of out-of-network patients from PIH Health Hospitals to the patient’s contracted facility.

The RN ED 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 ED 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 ED Access Case Manager works to ensure appropriate utilization of hospital resources in all settings and levels of care.  The RN ED Access Case Manager is also responsible for completing discharge orders of patients discharge from the emergency department.

Works closely with Care Management Coordinators in arranging delivery of DMEs, post emergency visit care including but not limited to coordinating discharges to SNFs, Subacutes, LTACs, Hospice, Home with and without home health services, or arrangin…

Qualifications

Required Experience:

• Maintain an active California RN License
• Minimum of five (5) years of acute hospital nursing experience

Preferred:

• CCM or ACM (Certified Case Manager, Accredited Case Manager)
• BSN
• Minimum of one (1) year acute hospital nursing experience in Critical Care or Emergency Department
• Previous experience in case management.
• Knowledge of payer requirements and previous experience in case management or bed control.

About the Hospital

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.