Case Manager Per-Diem Days Full Time

About The Position

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.