9 Case Manager Jobs in Arcadia, CA
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Methodist Hospital is Hiring a Case Manager Near Arcadia, CA
POSITION SUMMARY
The purpose of the Case Coordinator position is to support the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions. The Case Coordinator is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include: facilitation of pre-certification and payer authorization processes, facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement, application of process improvement methodologies in evaluating outcomes of care support and coaching of clinical documentation efforts and serving as a clinical resource for coders, ensuring that documentation accurately reflects severity of illness and intensity of service coordinating communication with physicians.
ESSENTIAL JOB FUNCTIONS AND CORE RESPONSIBILITIES
- Actively participates in clinical performance improvement activities.
- Applies approved InterQual criteria to monitor appropriateness of admissions and continued stays and documents findings based on department standards.
- Assist in the compilation of physician profile data regarding LOS, resource utilization, denied days, cost, case mix index, patient satisfaction, and quality indicators.
- Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials, and appeals.
- Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
- Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
- Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated caseload; monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis: completion and reporting of diagnostic testing, completion of treatment plan and discharge plan, modification of plan of care, as necessary, to meet the ongoing needs of the patient, communication to third-party payers and other relevant information to the care team, assignment of appropriate levels of care, completion of all required documentation in Affinity GUI screens and patient records
- Collaborates/communicates with external case managers.
- Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
- Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
- Completes utilization management for assigned patients.
- Coordinates/facilitates patient cares progression throughout the continuum.
- Documents relevant discharge planning information in the Affinity GUI System according to department standards.
- Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the health care team and are documented as necessary to ensure continuity of care.
- Ensures/maintains plan consensus from patient/family, physician, and payer.
- Facilitates transfer to other facilities.
- Identifies at-risk populations using approved screening tool and follows established reporting procedures.
- Initiates and facilitates referrals to the Home Health Liaison for home health care, hospice, and medical equipment and supplies.
- Issues Notices of Non-coverage per hospital policy.
- Manages all aspects of discharge planning for assigned patients.
- Meets directly with patient/family to assess needs and develop an individualized plan in collaboration with the physician.
- Monitors all transfer DRG’s.
- Monitors length of stay (LOS) and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
- Perform 100% UR Review on all Medicare One-Day admissions.
- Proactively identifies and resolves delays and obstacles to discharge.
- Refers appropriate cases for social work intervention based on department criteria.
- Refers cases and issues to physician advisor in compliance with department procedures and follows up as indicated.
- Seeks consultation from appropriate disciplines/ departments as required to expedite care and facilitate discharge.
- Uses data to drive decisions and plan/implement performance improvement strategies related for assigned patients, including fiscal, clinical, and patient satisfaction data.
- Uses quality screens to identify potential issues and forwards information to the PI department.
- Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
- Works collaboratively and maintains active communication with physicians, nursing, and other members of the multidisciplinary care team to effect timely, appropriate patient management.
JOB REQUIREMENTS
Education
Minimum (Required)
Bachelor’s Degree in Nursing
Preferred (Not required)
Work Experience
Minimum (Required)
Preferred (Not required)
Licenses and Certifications
Minimum (Required)
- A current RN licensure in the State of California is required.
- Must successfully complete and maintain BLS certification.
Preferred (Not required)
Professional certification as a case manager preferred.
Required Skills, Knowledge, and Abilities (SKA’s)
- Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
- Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
- Excellent interpersonal communication and negotiation skills.
- Minimum three years clinical experience in Utilization Review and Discharge Planning in an Acute Hospital strongly preferred Strong analytical, data management, and PC skills.
- Strong organizational and time management skills, as evidenced by a capacity to prioritize multiple tasks and role components.
- Understanding of pre-acute and post-acute venues of care and post-acute community resources.
At USC Arcadia Hospital, you’ll enjoy an excellent compensation and benefits package (Medical, Dental, Vision, Retirement Savings Plan with match, Life Insurance, Flexible Spending Account, Employee Assistance Program, Tuition Reimbursement, Paid Time Off, Free On-Site Parking, Child Care, Employee Referral Bonus Program, etc.), including professional development programs, and much more.
Living and Working in the San Gabriel Valley:
The City of Arcadia is located in the beautiful San Gabriel Valley, which is one of the best places to live and work in California and is just 15 miles north of downtown Los Angeles. The region offers a multitude of diverse entertainment, shopping and exceptional restaurant options. The San Gabriel Valley is less than an hour away from sunny Southern California beaches, and less than two hours away from local mountain resorts like Big Bear and Lake Arrowhead.
Locally, Arcadia is a wonderful, thriving community featuring the Los Angeles County Arboretum and Botanic Gardens as well as the Santa Anita Park racetrack, and is located next to the City of Pasadena, which hosts the New Year’s Day Rose Parade and Rose Bowl game annually. The region boasts excellent public and private schools and universities close by, including Cal Tech, USC, UCLA, Cal State Northridge, Cal Poly Pomona, Azusa Pacific University and the Claremont Colleges. Arcadia was recently named “Best Place to Raise Your Kids” by Bloomberg Businessweek magazine and is the perfect place to call home.
Pay Transparency
The hourly rate range for this position is $47.00 - $76.69. When extending an offer of employment, the University of Southern California Arcadia Hospital considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, State, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Hospital
SALARY
$47-77 (estimate)
POST DATE
01/29/2023
EXPIRATION DATE
01/30/2024
WEBSITE
methodisthospital.org
HEADQUARTERS
ARCADIA, CA
SIZE
1,000 - 3,000
FOUNDED
1903
TYPE
NGO/NPO/NFP/Organization/Association
CEO
DAN F AUSMAN
REVENUE
$200M - $500M
INDUSTRY
Hospital
Related Companies
About Methodist Hospital
Methodist is a full-service community hospitalserving communities in the San Gabriel Valley.
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The job skills required for Case Manager include Case Management, Patient Care, Coordination, Health Care, Planning, Social Work, etc. Having related job skills and expertise will give you an advantage when applying to be a Case Manager. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Case Manager. Select any job title you are interested in and start to search job requirements.
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The following is the career advancement route for Case Manager positions, which can be used as a reference in future career path planning. As a Case Manager, it can be promoted into senior positions as a Case Management Director that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Case Manager. You can explore the career advancement for a Case Manager below and select your interested title to get hiring information.
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