Care Manager

Role:
The Care Coordinator manages and coordinates patient care throughout an episode of illness or treatment, working closely with patients, families, physicians, multidisciplinary care teams, and payors. The role combines clinical assessment, care planning, utilization management, and patient advocacy to support quality, efficient, and cost-effective outcomes.

Key Responsibilities:

• Coordinate patient care from admission through discharge or appropriate transfer.
• Assess, plan, implement, and evaluate care using the nursing process.
• Collaborate with patients, families, physicians, care teams, and payors to ensure continuity of care.
• Monitor and evaluate quality and utilization cases, including admission/discharge criteria, observation and 1-day stays, 30-day readmissions, Medicare criteria, and diagnosis-related criteria.
• Participate in ongoing outlier reviews and utilization management activities.
• May provide care coordination support within the Emergency Department.
• Monitor patient progress and ensure appropriate, efficient, and cost-effective use of healthcare resources.
• Advocate for patients and families throughout the entire care episode.
• Facilitate communication among healthcare providers and monitor services provided.
• Remain involved until discharge, transfer to an acute care setting, or transition to an alternate level of care.
• Initiate appropriate clinical pathways based on the patient's admission diagnosis.
• Serve as a clinical resource for utilization management activities.

Minimum Requirements:

• At least 1 year of recent Case Management experience in an acute care setting.
• Current California RN license.
• Current CPR certification/recognition