| Job ID |
Specialty |
Geographic Location |
City |
State |
Recruiter |
| 2346777 |
Case Manager-RN |
15.9 miles from Los Angeles |
Santa Monica |
CA |
The Clinical Recruiter |
Company Name: The Clinical Recruiter
Recruiter Name: Chris Monroe
Contact Phone: 615-547-2432
Job Title: Case Manager Patient Care Services
In HouseID: 32197
15.9 miles from Los Angeles (Only QUALIFIED Healthcare Professionals accepted) Case Manager-RN - Case Manager Patient Care Services
Santa Monica, California
JO# 32197
* Relocation Assistance *
Summary:
The Case Manager assumes 24-hour responsibility and assists with the direction, management, and evaluation of the Case Management|Social Work departments.
Reports to the Director of Case Management and assists with clinical, operational, and financial aspects of the Case Management|Social Work departments.
Manages all aspects of Case Management and Utilization Management, including admission and continued stay medical necessity reviews, payer authorization, discharge planning, denials management, and ensures adherence to the case management plan.
Assists with hiring, training, directing, development and evaluating of staff.
Assists with development of action plans, and may report outcomes to the Case Management Director, CNO, or others as applicable.
Assists with the design, implementation, training, and resources for the Care Management system for the organization.
Evaluates personnel, assesses environment, and determines priorities for care in order to plan, implement, and evaluate outcomes of care.
Evaluates the effectiveness of existing clinical protocols and pathways and makes recommendations for new ones.
Works effectively with MCO staff and leadership to decrease denials or downgrades in reimbursement.
Ensures collaboration among health care providers across the Continuum of Care to maximize effective access and efficient utilization of resources.
Experience:
Minimum of two (2) years practical nursing experience
Previous coding and abstracting experience
Ability to determine acuity of medical condition through knowledge of medical terminology and knowledge
Education:
Bachelor of Science in Nursing (BSN) required
Master’s Degree in Nursing or a related healthcare field preferred
Certifications|Licensures:
Registered Nurse License required
Certification in Case Management (CCM, ACM) required
Specialty Certification in Oncology, Rehab, Pediatrics, Transplant or Wound Care
Healthcare Quality of Utilization Review (HQUR) a plus, not required
Special Skills:
Must be able to utilize independent decision-making skills in a wide variety of situations
Frequent contact with employees, physicians, customers, community individuals and volunteers
Must be self-motivated to complete work in a timely manner to meet deadlines
Experience with Core Measures, Quality Indicators, CM and utilization
Knowledge base of InterQual criteria
Knowledge of Managed care trends, Medicare and Medicaid regulations
Advanced negotiation and mediation skills
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