Triage nurse case Manager in Orange at Prospect Medical Systems

Date Posted: 11/9/2020

Job Snapshot

Job Description

Triage nurse case Manager

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Triage nurse is responsible for screening, coordinating and facilitating transfers, admissions or discharges for all patient’s emergency room calls. In addition, the triage case manager will work collaboratively with internal and external interdisciplinary staff when facilitating transfers from out of network to in network hospitals or higher level of care transfers. The triage case manager will ensure that each patient that is admitted meets established medical necessity guidelines from MCG.

Job Responsibilities/Duties

  • Triage all emergency room calls and make a determination in collaboration with the physician and using MCG guidelines on whether patient meets criteria for admission, transfer or discharge to a lower level of care.
  • Facilitate transfer of stable patients from out of network non-contracted hospitals to the appropriate in network contracted hospitals based on the IPA/MSO contracts.
  • Determine the appropriate Level of care for admissions based on the severity of illness and the intensity of care or treatment plan. Completes the initial MCG review for admitted patients.
  • Communicates issues regarding benefits and utilization to physician, hospital staff and patient regarding the hospitalization
  • Facilitates higher level of care transfers and completes transfer back agreements when required.
  • Assist and work as an inpatient case manager when needed.

Minimum Education: Licensed Vocation Nurse or Registered Nurse. Registered nurse is preferred.

Minimum Experience: A minimum of two (2) years of direct patient care in acute care setting. Emergency room and Critical Care experience in acute care is desirable. Previous experience as a transfer nurse in managed care or Emergency room case manager at acute care facility. Two years of experience in Case Management, Utilization Management and discharge planning is required. Knowledge of state and federal regulations like EMTALA, AB 1203. Expert knowledge of MCG to make determination if patient meets criteria for admission. Demonstrates knowledge of utilization review process, critical thinking skills and using clinical judgement to determine if patient meets criteria for admission, transfer or discharge. Knowledge of the different lines of business in case management for Medicare Advantage, Commercial and Medi-Cal. Effective communication skills when working with a diverse interdisciplinary team of physicians, case managers, social workers and other hospital staff.

Req. Certification/Licensure: Licensed Vocation Nurse or Registered Nurse. Registered nurse is preferred.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law:

Keywords: Triage, RN, LVN, Case Management, Critical Care, Emergency Room, Utilization, IPA, MSO