RN I, Case Manager (Part-time)

Description

Professional Duties

• Complete the initial medical necessity review and post stabilization criteria box at the time of case opening for each assigned patient.
• Complete daily review of medical necessity for all assigned admitted patients utilizing the established criteria and guidelines.
• Identify potential delays in patient care or discharge and communicate findings to Medical Director and/or department management for intervention as deemed appropriate.
• Communicate with Providers to ensure timely consultations, confirm plan of care, level of care and address any potential barriers to a safe discharge for each assigned patient.
• Identify aberrant days in hospital process and compile documentation and information to substantiate findings. Report findings to department management to ensure that the organization is not financially responsible for these avoidable days.
• Send denial documentations to patient, power of attorney or next of kin in accordance with State and Federal regulatory guidelines and in accordance with departmental policies, procedures and timelines.
• Identify quality and utilization issues and report findings to the Quality Improvement department for review.
• Conduct discharge screenings on all admissions and emergency room visits and anticipate discharge planning needs. Send completed medical records packet to appropriate departments.
• Participate in weekend and Holiday coverage rotation as scheduled and requested by management.
• Perform other duties as assigned.
• Address customers as Mr., Mrs., or Ms. until invited to do otherwise. Never use terms of endearment such as hon, dear, sweetie, etc.
• Speak clearly and use understandable language (avoid medical jargon or slang)
• Offer to answer any additional questions that the person, patient or customer may have

Qualifications

• High school diploma or equivalent required. Bachelor's degree in Nursing, preferred.
• Current RN licensure in the State of California required.
• 2 years of healthcare or case management experience in a clinical setting required.
• 2 years of chart review and analysis experience, preferred.
• Knowledge of diagnostic and invasive procedures and ability to anticipate changes to the care plan based on findings.
• Knowledge of the criteria of Level of Care, Intensity of Service and Severity of Illness criteria. Knowledge of discharge screens, skilled Nursing and Home health criteria.
• Ability to utilize Microsoft Office applications (Word, Excel, Outlook, Power Point) and other computer software/applications.
• Ability to communicate effectively with individuals at all levels of the organization, as well as with patients, family members and vendors.
• Detail oriented and ability to manage time effectively and prioritize tasks to meet established deadlines.
• Current California driver's license and proof of auto insurance.

Physical Demands