Title: RN, Case Manager, Inpatient

Location: Fountain Valley

Department: Inpatient/Specialty Services

Status: Full-time

Shift: Day

Pay Range*: $55.05/hour - $79.83/hour 

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

In collaboration with Physician Leaders, Directors, Department Managers, and Supervisors. The Care Transition Registered Nurse (RN) is responsible for supporting the activities of MemorialCare Medical Foundation’s (MCMF) Inpatient and Care Transitions Program.

The Care Management RN provides comprehensive care coordination services, including but not limited to initial and concurrent reviews, supports high‑risk discharge planning, transitional care processes. This role supports patients across the continuum of care while contributing to the strategic goals and quality initiatives of MemorialCare Medical Foundation.

Essential Functions and Responsibilities of the Job

1. LANGUAGE SKILLS:Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.Ability to write routine reports and correspondence.Ability to speak effectively before groups of customers or employees of the organization.

2. REASONINGABILITY: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.Ability to deal with problems involving a few concrete variables in standardized situations.

3. OTHER SKILLS and ABILITIES: Proficient on Microsoft Word, Excel, Outlook and PowerPoint. Strong oral and written communication and research/problem solving skills. Attention to detail and accuracy.Ability to meet deadlines.Excellent interpersonal skills with a focus on internal/external customer satisfaction and teamwork.Proven dedication to quality, teamwork, customer service and professionalism.

4. Provide Transition of Care and Utilization Management support for MemorialCare Foundation patients identified in care settings: Emergency Department, Observation Unit, Acute Inpatient, LTACH, sub-acute, and ARU. Supports the inpatient bedside care management teams with medical necessity and appropriateness of the level of care information.

5. Adherent to regulatory compliance, contracted, delegated and non-delegated health plans supporting patient populations including but not limited to Medicare Advantage, Commercial, PPO, Service and ACO.

6. Provide evidence-based clinical care, patient-centered care, promoting efficiency in the delivery of value-based care and quality per the scope of their licensure.

7. Utilize Nursing Process and Case Management principles in the delivery of care.

8. Be at work and be on time.

9. Follow company policies, procedures and directives. Maintain a strict degree of confidentiality as related to HIPAA and Compliance.

10. Interact in a positive and constructive manner as a member of the healthcare team.

11. Prioritize and multitask.

12. Supports the organization’s goals and mission statement and in a professional manner.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Minimum Requirements

Qualifications/Work Experience:

• Previous Case Management experience in a managed care or hospital setting preferred
• Experience applying evidence-based guidelines and criteria (i.e.: MCG, InterQual, CMS); Health plan medical policy / clinical coverage guidelines required
• Work experience in an Electronic Medical Record, Microsoft Word, Microsoft Excel and Microsoft Outlook required
• A minimum of two (2) years’ Clinical Nursing Experience in a hospital or like setting required
• Knowledge of CMS (Centers for Medicare and Medicaid Services) coverage policies required

Education/Licensure/Certification:

• Current California Registered Nurse license (RN) required
• Associate's degree (AA) in nursing or equivalent from a two-year college or technical school required
• Bachelor of Science or Master’s Degree in Nursing or related field preferred
• CCM preferred