RN Case Manager – Pre-Access (Per Diem)
Valley Presbyterian Hospital
Ensure the Right Care, at the Right Time, in the Right Setting
At Valley Presbyterian Hospital, our Case Management team plays a critical role in supporting patient access, regulatory compliance, and efficient care delivery. We are seeking an experienced RN Case Manager – Pre-Access to coordinate admission reviews, facilitate patient transfers, and ensure appropriate patient status determinations based on medical necessity guidelines. This role serves as a key liaison between physicians, nursing, admitting, financial services, and external healthcare organizations to support seamless patient access and optimal utilization of hospital resources.
What You'll Do
- Review all acute care admissions to ensure appropriate patient status and level of care using established medical necessity criteria
- Conduct admission reviews utilizing InterQual and other proprietary utilization review tools
- Document admission determinations within the electronic medical record and utilization management systems
- Collaborate with admitting physicians, Emergency Department providers, and hospital leadership to determine the most appropriate level of care
- Coordinate patient transfers into the hospital, including obtaining clinical information and transfer agreements
- Serve as a liaison between physician offices, admitting, nursing, business office, and ancillary departments to facilitate efficient admissions
- Initiate physician advisor referrals when admission status or level-of-care determinations require additional review
- Monitor observation patients and ensure appropriate status changes and documentation
- Collaborate with Emergency Department leadership to improve patient throughput and bed utilization
- Partner with Operations Supervisors regarding bed placement, patient flow, and special admission needs
- Communicate payer requirements, utilization concerns, and reimbursement-related issues to physicians and care teams
- Participate in departmental meetings, bed board huddles, and performance improvement initiatives
What You Bring
- Strong clinical assessment and critical thinking skills
- Expertise in utilization review, admission status determination, and medical necessity criteria
- Knowledge of InterQual, CERME, Medicare, Medi-Cal, managed care, and third-party payer requirements
- Understanding of EMTALA and other federal and state healthcare regulations
- Ability to exercise independent judgment and make sound clinical decisions
- Excellent communication and relationship-building skills
- Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment
- Ability to work collaboratively with physicians, nursing, case management, and operational teams
Experience
- Minimum two (2) years of direct acute care nursing experience required
- Critical Care experience preferred
- Previous Case Management, Utilization Management, or Discharge Planning experience preferred
Education
- Bachelor of Science in Nursing (BSN) required
Requirements
- Current California Registered Nurse (RN) license
- Management of Assaultive Behavior (CPI or equivalent) certification within 30 days of hire
- LA City Fire Card certification within 30 days of hire
Why VPH
- Mission-driven healthcare organization dedicated to exceptional patient care
- Opportunity to impact patient access, quality, and resource utilization
- Collaborative interdisciplinary environment
- Dynamic role supporting hospital-wide patient flow and admission operations
- Professional growth opportunities within Case Management and Care Coordination
Apply today and help ensure patients receive the appropriate care at the appropriate level while supporting operational excellence at Valley Presbyterian Hospital.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.
