RN Care Manager Inpatient Full Time (10hrs)
Company: Martin Luther King, Jr. Community Hospital
Location: Whittier
Posted on: January 8, 2026
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Job Description:
If you are interested please apply online and send your resume
to yadeleon@mlkch.org POSITION SUMMARY The purpose of the Case
Manager I position supports the physician and interdisciplinary
team in facilitating 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 payors. The role integrates and coordinates the
functions of utilization management, care progression and care
transition. The Case Manager I is accountable for a designated
patient caseload and plans effectively to meet patient needs,
manage the length of stay, and promote efficient utilization of
resources. Specific functions within this role include:
Facilitation of precertification and payor 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
Coordinating communication with physicians. The role reflects
appropriate knowledge of RN scope of practice, current state
requirements, CMS Conditions of Participation, EMTALA, The Patient
Bill of Rights, AB1203 and other Federal or State regulatory agency
requirements specific to Utilization Review and Discharge Planning.
The Care Manager partners with the medical staff, utilizes
scientific evidence for best practices, and relevant data to manage
the care of the patient over the continuum of their
hospitalization. These activities include admission, continued,
extended and discharge reviews in all reimbursement categories to
determine medical necessity, assure high quality of care and
efficient utilization of available healthcare resources, facilities
and services. This position requires the full understanding and
active participation in fulfilling the Mission of Martin Luther
King, Jr. Community Hospital. It is expected that the employee will
demonstrate behavior consistent with the Core Values. The employee
shall support Martin Luther King, Jr. Community Hospital‘s
strategic plan and the goals and direction of the quality and
performance improvement process activities. ESSENTIAL DUTIES AND
RESPONSIBILITIES Assessment: Completes a comprehensive assessment
to identify opportunities for intervention that are appropriate and
realistic for the patient/family‘s psycho-social, cultural,
spiritual, and physical plan of care. Assess the patient‘s
healthcare needs and goals; specifically targeting the physical,
functional, psychosocial, environmental and financial status.
Completes and documents timely clinical reviews based on assessment
of medical necessity and documented clinical findings in accordance
with Hospital policy and payer requirements. Communicates with
attending physician regarding appropriateness of patient
admissions, resource utilization, and when documentation does not
support continued stay. Assesses readmission risk based on
established Hospital criteria. Planning: Demonstrates an
understanding of medical necessity and intensity of service, and
incorporates payer requirements into the development of a safe,
effective, and timely discharge plan. Demonstrates an understanding
of the patient‘s clinical condition, social, and financial
resources to determine the most appropriate care setting, practice
standards for evaluation, treatment delivery options (Home, SAR,
SNF, LTACH, Acute Rehabilitation, Assisted Living, Board/Care,
Recuperative Care, Shelter), and resources required to support safe
transition of care. Incorporates risk of readmission and
socio-economic factors in the creation of a safe and individualized
transition plan. Engages the patient and family/support network in
developing the transition plan. Collaborates actively with the
interdisciplinary team throughout the patient‘s stay to re-assess
and adjust the plan for care progression and transition according
to the patient‘s clinical condition. Advocates for the patient with
the payer and/or IPA to ensure the most effective care progression
and transition plan for the patient. Implementation: Coordinates
the progression of care to ensure that the ongoing needs of the
patient and family are adequately addressed. Identifies
psychosocial and financial barriers, (e.g. substance abuse,
homelessness, unsafe or abusive living arrangement) and
collaborates with or delegates to Clinical Social Work colleagues.
Identifies discharge planning needs and facilitates transfers to
acute and post-acute venues. Demonstrates working knowledge of the
clinical requirements, individual payer networks and coverage, and
impact of patient‘s living environment and support network in
creating a transition plan. Identifies and facilitates home care
and durable medical equipment needs at the time of discharge.
Facilitates palliative or hospice care when needed Works
collaboratively and maintains active communication with physicians,
nursing and other members of the interdisciplinary care team to
ensure timely and effective care progression and achievement of
desired outcomes. Oversees discharge planning and facilitates safe
transitions to community settings. Addresses/resolves system
problems impeding diagnostic or treatment progress. Proactively
identifies and resolves delays and obstacles to discharge. Seeks
consultation from appropriate disciplines/departments as required
to expedite care and facilitate discharge. Coordinates and monitors
scheduling of tests/procedures of patients and reports results to
other healthcare members when appropriate. Identifies recurrent
problems and recommends strategies for resolution. Evaluation
Develops and evaluates case management plans and protocols in
collaboration with the interdisciplinary team. Evaluates actions
taken to assure cost-effective care including physician length of
stay, diagnostic related groups cost reporting, morbidity and
mortality reports and monitoring of readmissions. Utilizes
avoidable day reporting tool to identify sources of barriers to
patients‘ progression of care. Communication/Collaboration: Serves
as a liaison between members of the interdisciplinary care team,
community providers, payers, and patient/family to ensure safe and
effective plans and smooth transitions between internal and
external levels of care. Ensures consistent and timely
communication with Patient Financial Services and HIM as needed to
confirm patient status and/or authorization to support the billing
process. Collaborates with medical staff, nursing staff, and
ancillary staff to eliminate barriers to efficient delivery of
care. Collaborates with attending physicians and consultants to
review and discuss patient care, progress and identified outcomes.
Defines and manages deviations from the plan of care. Participates
in and or facilitates patient care conferences and family meetings.
Provides support and clinical expertise for nursing/ancillary
personnel related to patient care issues. Maintains communication
with Nurse Managers and other Case Managers relative to individual
patient care and/or system problems. Assures prompt reporting of
medical/legal issues to Risk Management and appropriate
Administrative parties. Facilitates peer to peer discussions
between attending physicians, Case Management Consultants, and
Physician Advisor in cases requiring evaluation and justification
of medical necessity for admission by the payer. Utilizes advanced
conflict resolution skills as necessary to ensure timely resolution
of issues. Professionalism: Within the nursing scope of practice,
the care manager continuously assesses self-knowledge and
competencies to assure job performance. Actively participates in
departmental meetings and shares knowledge related to the practice
of case management Demonstrates understanding of Medicare
Conditions of Participation as related to discharge planning,
patient/family engagement, and communication of financial
responsibility. Maintains respect for the dignity of every person
by addressing issues and concerns with workers directly, with a
positive problem-solving approach, and the observance of the right
to patient privacy and confidentiality. Demonstrates concern,
respect, and caring for all customers, both internal and external,
regardless of their diagnosis or socioeconomic status. Maintains
positive interpersonal relations. Performs other related job duties
as assigned. POSITION REQUIREMENTS A. Education Bachelor of Science
degree in nursing preferred Associates in Nursing required ? B.
Qualifications/Experience Minimum of one (1) to three (3) years of
hospital or related experience is required. Internals with at least
18 months of acute care case management/coordination experience
will be considered in lieu of nursing clinical experience. Able to
navigate and connect successfully with outside provider networks
(Health Plans, IPA‘s, and FQHC‘s). C. Special Skills/Knowledge
Bilingual language skills preferred (Spanish) Basic computer skills
Current California Nursing license Current Basic Life Support (BLS)
Certification in Case Management preferred. ED Care Managers: Must
complete annual Workplace Violence Prevention Program/Certificate,
per hospital policy, during initial training/orientation but not to
exceed 90 days from hire/transfer. LI-YD1 MLKCH Video
Keywords: Martin Luther King, Jr. Community Hospital, Whittier , RN Care Manager Inpatient Full Time (10hrs), Healthcare , Whittier, California
