Registered Nurse

Join Our Team as a Registered Nurse - Case Manager in Mission Viejo, CA

We are actively seeking a dedicated and experienced Registered Nurse to join our dynamic Case Management team. This is a fantastic opportunity for a skilled professional passionate about delivering exceptional care coordination and utilization review within an acute hospital setting. If you thrive in a fast-paced environment and possess recent acute medical care manager experience, we encourage you to apply and become an integral part of our mission to provide outstanding patient care.

Shift Information

• Day Shift: Monday to Friday
• Hours: 8:00 AM – 4:30 PM (5 days x 8 hours)

Requirements & Skills

• Minimum 2 years of acute medical Care Manager experience performing care coordination, with recent experience within the last 3 months (HARDSTOP)
• Experience with Epic charting system (required)
• Travel experience in healthcare settings (required)
• Experience working in an acute hospital environment
• Proficiency in case management and utilization review, including:
  • Appeals and denials
  • Care coordination
  • Disability case management
  • Discharge planning
  • Disease management
  • Needs assessment and ordering Durable Medical Equipment (DME)
  • Plan of care development
  • Worker’s compensation case management
• Familiarity with healthcare regulatory standards including:
  • CMS (Centers for Medicare and Medicaid Services)
  • Department of Health regulations
  • DRG (Diagnosis Related Groups)
  • HIPAA guidelines
  • OSHA standards
  • The Joint Commission Core Measures and National Patient Safety Goals
  • Workers Compensation regulations
• Acute hospital experience, specifically in:
  • Emergency Department (required)
  • Intensive Care Unit (ICU) (required)
  • Medical-Surgical units
  • Surgical Services (required)
• Preferred experience in Trauma Level I and Trauma Level II settings
• Additional skills including completion of extra checklists as required

Key Responsibilities

• Perform comprehensive care coordination and case management for patients within an acute hospital setting
• Conduct utilization review to ensure appropriate care levels and compliance with regulatory requirements
• Manage appeals and denials processes efficiently to support patient care and reimbursement
• Develop, implement, and monitor individualized plans of care in collaboration with multidisciplinary teams
• Coordinate discharge planning and follow-up resources to promote optimal patient outcomes
• Order and coordinate durable medical equipment (DME) as needed according to patient assessments
• Maintain strict adherence to HIPAA, OSHA, and regulatory guidelines including CMS and The Joint Commission standards
• Utilize Epic Electronic Medical Records (EMR) system for documentation and communication
• Provide case management support for worker’s compensation and disability cases
• Participate in quality improvement initiatives and ensure compliance with National Patient Safety Goals

Qualifications

• Current and valid Registered Nurse (RN) license in California
• Minimum of 2 years recent acute medical care manager experience with a focus on care coordination
• Proficiency with Epic charting system
• Demonstrated ability to work in high-acuity areas including Emergency Department, ICU, and Surgical Services
• Strong knowledge of healthcare regulations and standards at the state and federal level
• Excellent communication and organizational skills with the ability to collaborate across multidisciplinary teams
• Travel experience within healthcare settings is a requirement

Compensation and Benefits

We offer a competitive hourly rate of $59.00 – $70.00, paid weekly. This position is offered through Quick2Hire staffing agency, where you will have a dedicated recruiter to support your career journey and provide ongoing assistance.

If you meet the requirements and are eager to advance your career as a Registered Nurse Case Manager, apply today and take the next step toward making a meaningful difference in patient care!

This healthcare facility is a cornerstone of medical excellence in the region, offering a comprehensive range of services designed to meet the diverse needs of the community. With a focus on patient-centered care, the facility provides primary care, urgent care, and specialized services such as cardiopulmonary testing, diagnostic imaging, and a state-of-the-art birthing center. The facility's commitment to compassionate care is evident in its extensive behavioral health and chemical dependency programs, ensuring holistic support for patients. Additionally, the presence of the Otto Klein Cancer Center and a robust orthopedics department highlights its dedication to specialized and advanced medical treatments.

Located in the picturesque town of Polson, MT, the facility serves a vibrant community nestled along the shores of Flathead Lake. This location offers healthcare professionals the unique opportunity to work in a serene environment that balances professional growth with quality of life. The facility is part of a not-for-profit Catholic health care ministry, emphasizing its mission to provide accessible, high-quality care while fostering a supportive and inclusive work culture. With a commitment to innovation and community well-being, this healthcare facility is an ideal place for professionals seeking to make a meaningful impact while enjoying the natural beauty and recreational opportunities of Montana.