- Assessing all patients based on appropriate criteria (severity of illness/intensity of service) for acute care and admission in appropriate setting (ICU, Med/Surg, OB, Peds, Rehab)
- Interviewing the patients or significant others to identify post hospital care needs within a timely manner and arrange ancillary service needs identified (HHC, HME, Hospice, transport, etc).
- Coordinating patient transfers between facilities.
- Assessing the patient for appropriate level of care using the Severity of Illness/Intensity of service criteria.
- Referring appropriately to allied health personnel and community resources.
- Providing clinical consultation on difficult cases or initiates multidisciplinary care consultations as needed relating to acute care or alternative levels of care.
- Exhibiting open communication with physicians and Physician Advisors to facilitate discharge plans and provide the highest quality of care using established criteria.
- Serving as a resource for physicians, hospital staff, and outside agencies in reference to insurance criteria and governmental regulation.
- Delivering letters of denial, re-determination, and/or referrals to patients, MDs, and billing office upon notification.
- Assisting nursing in communicating to Health Department regarding TB screening for authorized discharges.
- During interview process may need to assist patient (turn, lift up, etc.).
- Maintaining confidentiality of departmental and patient’s information.
- Demonstrating knowledge of age specific care, including but not limited to, identifying the need for additional safety measures, physiological normal values/readings; and assessing skin integrity, behavior, motor skills and/or activities that place patients at risk as well as communicates effectively in a clear, concise, understandable manner. Applicable for all populations, infant, pediatric, adult, geriatric.
- Pulling files for TARs requested by Physicians required for billing.
- Appealing errors discovered in authorization process relative to payer's criteria and process.
- Graduate of an accredited RN Program
- Completion of Case Management Course Preferred
- Minimum two years’ experience as a RN in an acute care setting.
- Ability to communicate effectively verbally and in writing.
- Must be able to work in a union environment.
Preferred Work Experience and Qualifications:
- Minimum two years as a Case Manager Preferred.
- BLS Card
- Current Los Angeles County Fire Card required (within 30 days of employment).