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About The Position
The fundamental focus of the case manager is to integrate, coordinate, and advocate for individuals, families, and groups requiring extensive services to achieve desirable patient outcomes, efficient utilization of resources, patient satisfaction and involvement, and appropriate lengths of stay.
Requirements
- Graduate of an accredited RN Program
- 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.
- AHA BLS Card
- Current Los Angeles County Fire Card required (within 30 days of employment).
Nice To Haves
- Completion of Case Management Course Preferred
- Minimum two years as a Case Manager Preferred.
Responsibilities
- 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.
