Nurse, RN Inpatient Case Mgr
Company: North American Staffing Group
Location: Montebello
Posted on: May 16, 2022
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Job Description:
Job DescriptionMedica Talent Group is excited to share this
direct-hire opportunity with you! Our client, a well-known and
reputable Managed Care Organization in the Los Angeles County area
is seeking a Nurse, RN Inpatient Case Mgr. to join their growing
team. This is a wonderful opportunity for an individual seeking to
expand their knowledge in the Managed Care arena. This organization
offers competitive salary, full benefits and much more!Overview:The
RN Case Manager will provide daily care coordination with
concurrent review for patient in the hospital or Skilled Nursing
Facilities (SNF) in person or telephonically. This position will
also provide case management to patients who are admitted to the
hospital and those patients who may need to be enrolled in
ambulatory case management. The RN case manager will be responsible
for identifying (California Children Services) CCS cases, handle
transfers, and retro reviews. Works as part of an interdisciplinary
care team coordinating care and collaborating with social work,
ambulatory case management, and Regional Medical Directors,
Hospitalist, the hospital nursing personnel, and with the physician
in the clinic. The RN Case Manager will be expected to perform
assessments and use the appropriate guidelines to ensure the
patient is receiving the appropriate level of care.
Qualifications:- Graduation from an accredited nursing program.-
Current valid License as a Registered Nurse through the California
Board of Registered Nursing; Bachelor's degree in nursing, or
another health or human services field with the appropriate
licensure preferred. - Experience in and willingness to be part of
multi-disciplinary team. - Experience with physically or mentally
impaired adults and/or geriatric population.- Three years RN
experience in public health nursing, acute care, case management
and/or home health care required; minimum of 2 years of managed
care experience in case management with focus in inpatient and/or
outpatient ambulatory care preferred. - Bilingual in English and
Spanish preferred. Responsibilities:- Responsible for daily
concurrent reviews, retro reviews, discharge planning,
pre-certification/prior authorization request review, and ensures
patients meet appropriate level of care based on acceptable
evidence-based Clinical Criteria(s). (InterQual and / or Milliman)
- Follows established policies, procedures, workflows, and desktop
procedures of the department. - Effectively and efficiently manages
patients throughout the continuum of care. - Works collaboratively
with hospitalists, hospital partners, and care teams to provide
holistic patient care that is focused on high quality in a
cost-effective way. - Develops a working relationship with the
hospital case managers, health plan, clinics, hospitalists, and
other governing entities. - Works with hospital discharge planners
and assists in the coordination of support services. - Rounds and
reports daily with Regional Medical Director, RN Leadership, and
hospitalists to collaborate on Plan Care and Discharge Plan. -
Rounds and reports daily catastrophic cases (> 10days) and full,
dual, and shared risk patients to RMDs and RN Leadership - Attends
Joint Operation Meetings (JOM) meetings and various community
meetings as needed. - Responsible for the daily review and
processing of referral authorizations in accordance with turnaround
time (TAT) standards set by ICE/Health Plan requirements. - Assists
in performing and documenting patient outreach telephonic and/or
face to face to ensure safe, appropriate discharge planning to
reduce the likelihood of readmissions and responsibilities includes
but not limited to PCP appointments, ensure DME Home Health is
ordered, referring for social barriers for referrals to social
workers. - Performs other related duties as assigned. - Responsible
for performing necessary assessments to provide adequate patient
care. - Responsible for formulating an appropriate and safe
transition of care plan to the next level of care. - Responsible
for ensuring discharge plan is obtained and communicated /
forwarded to PCP and/or next level of care provider. Skills and
Abilities:- Excellent customer service skills and ability to
resolve complex customer service issues and exercise conflict
management. - Ability to read, write and speak in a clear, accurate
and professional manner; includes active listening skills and
understanding medical terminology. - Ability to complete
basic/intermediate math computations and medical math conversions.
- Proficient in beginning/intermediate computer skills and typing.
- Excellent follow through skills, multi-tasking, prioritization,
and attention to detail. - Knowledge of the Case Management
Process, Chronic Care Model and Patient-Centered Medical Home Model
(PCMH). - Must be able to apply critical thinking skills and make
sound judgment at all levels throughout the patient's continuum of
care and make necessary referrals on behalf of P/P/C
(Patient/Provider/Caregiver). - Knowledge of regulatory
requirement, health plan contracts, governmental benefits, and
community resources. Thank you in advance for your time and
consideration!INDMED
Keywords: North American Staffing Group, Montebello , Nurse, RN Inpatient Case Mgr, Healthcare , Montebello, California
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