Job description
Case Manager
Shift: 8:00A – 4:30P
POSITION SUMMARY:
POSITION QUALIFICATIONS:
Education/License/Certification:
Experience/Skills:
POSITION SUMMARY:
- Under the direction of the Director of Care Management, the Case Manager uses pre-established guidelines and criteria to perform review activities assuring proper utilization of hospital resources for Medicare, Medi-Cal, HMO’s and other third party payers. Takes appropriate follow up action when established criteria for utilization of services are not met, in order to assure that denials are avoided. Identifies medically indigent patients and monitors closely to ensure that appropriate placement is secured; works with patient and family to determine if other sources of funding may be applicable
- Maintains appropriate documentation of review performed, according to pre-established criteria, indicating severity of illness and intensity of services rendered with acute/ post-acute hospitalization. Acts as Liaison with physician(s) to: ( 1) ensure all covered aspects of treatment are fully document, and (2) assist in identifying other options for care when patient no longer require acute hospitalization, securing appropriate referral for social services, discharge planning and home health services, and long-term care placement.
POSITION QUALIFICATIONS:
Education/License/Certification:
- Must have current licensure as a Registered Nurse in the State of California.
- Must have BSN or enroll in a BSN Program within 30-Days of start date and complete within 24-months from enrollment.
- Must have and maintain current BLS Certification or obtain within orientation process, prior to hands-on patient care.
- Certification in Case Management is preferred.
Experience/Skills:
- Must have one (1) year or more as a RN experience in Acute Care Setting.
- Prefer two (2) years of experience as a R.N. Case Manager.
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