The Case Manager assists the organization by assuring that the right care is provided at the right place, at the right time. To accomplish these goals, the Case Manager: uses established criteria to evaluate the appropriateness of admission, level of care, and readiness for discharge; assures the timely movement of patients throughout the continuum of care by conducting concurrent reviews and resolving delays as necessary; assesses patients’ post-discharge needs and develops and implements the plan; submits clinical information to assure reimbursement; and coordinates care with the treatment team, family and others as necessary.
This is a limited term, benefited position up to 1 yr.
Current California RN Licensure required.
BSN strongly preferred
National certification in Case Management (ACM, CCM) preferred.
Previous Leadership experience preferred.
- Minimum 3 years previous acute care experience or equivalent education commensurate with is required.
- Previous case management experience preferred.
- Broad acute clinical background (experience in more than one population and level of care) strongly preferred.
- InterQual experience preferred.
- Utilize critical thinking skills and clinical knowledge to create a viable and effective patient transition plan and identify delays in service, or quality issues that impede the progression of care required.
- Basic knowledge of governmental (Medicare, Medi-Cal, etc.) healthcare reimbursement systems is preferred.
- Advanced knowledge of healthcare reimbursement systems: HMO, PPO, capitated agreements, PPS, etc., preferred.
- Advanced knowledge of post-acute healthcare resources such as: SNF, Home Health, Hospice, AIM, etc., required.
- Intermediate level computer skills required.
- General typing skills (35 WPM) required.
- General knowledge of coding and DRG assignment process preferred.
- Must be able to effectively communicate with, and promote cooperation and collaboration between, multiple people including: patients and their families; physicians, nurses, social workers, etc. Ability to seek input and receive feedback in a collaborative interdisciplinary team.
- Able to orchestrate successful, complex discharge plans.
- Must be able to develop an organized work plan in a high-volume environment with rapidly changing priorities.
- Must possess leadership, delegation, and supervisory skills to guide staff and hold others accountable.
- Must be self directed and organized with the ability to independently prioritize and follow through to achieve desired clinical, satisfaction and financial outcomes.
- Must have strong clinical assessment skills necessary to provide utilization review and transition planning services to meet the patients’ complex medical, emotional and social needs.
- Professional Development
- Life Insurance
- Vacation/paid time off
- Flexible Spending Accounts
- Medical, Dental and Vision
- Retirement / Pension Plans
- Long Term Disability
- Tuition Reimbursement