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RN- CASE MANAGER -Full time - Fountain Valley - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | fountain valley, California |
About this job
RN- Case Manager - Full Time- 6-29-15
The Case Manager will assess admission necessity utilizing the IQ SI/IS criteria. Review date will be assigned. If treatment plan does not meet criteria, the UR nurse will refer case to attending physician. If no determination, the UR nurse will refer the case to the Medical Director.
The Case Manager will perform the initial IQ and clinical review, within one working day of admission and document in eCARE
The Case Manager will perform continued stay IQ and document in eCARE a concurrent review every 3 days or sooner if change in LOC or clinical status.
The Case Manager will review all Observation patients daily per P&P #8756-M 8.0
Prepares review sheets for all patients, Medi-cal, (via TAR) Medicare, IMS and cash as well as other financial classes.
Initiates discharge planning per Department standard. All payor sources are screened for high risk, high volume and problem prone patients.
Conducts interview with patients and significant others. Explores avenues of discharge planning.
Demonstrates a knowledge of human behavior and counseling skills as they relate to patient and staff needs.
Documents in eCare information and events as they occur. Maintain verbal and written communication with physician, staff, and family regarding discharge planning process. Notes signed (with name and title) and dated with each entry into the discharge planning record.
Implements innovative discharge planning when needs are out of the ordinary or resources unavailable. Utilizes insurance plan's case management for planning, if available.
Assists patients and families with information regarding social, economic and emotional aspects and makes necessary referral to social work, financial counseling or educational resources. Is a resources person to patients and families.
Assists physicians in transferring patients to other facilities. Coordinates exchange of information, records, transportation and notifications. Documents activities in Discharge Planning notes.
Educates medical and nursing staff on discharge planning for continuity of care. Lower level of care; i.e., role of HHC, SNF, REHAB, etc. Interprets Medi-care, Medi-Cal, IMS, private insurance and HMO's as they pertain to discharge planning.
Acts as a public relations person. Participates in meeting and inservices by outside providers. Network with others in the community.
Participates in and initiates case conferences. Attends rehabilitation rounds as indicated.
Assists in development of policies and procedures and documentation forms.
Completes activities related to Observation, one day stays, concurrent and retroactive TAR documentation.
Returns all telephone reviews to insurance companies within one working day.
Minimum Education: Knowledge necessary to obtain RN license in the state of California and current California RN license.
Minimum Experience: Three (3) to five (5) years experience in an acute care hospital setting preferred.
Preferred Skills and Abilities: Broad knowledge of Medicare, Medi-Cal and insurance guidelines. Good written and verbal communication skills.
NOTE: You must meet all elements of the job requirements noted above and complete the People Answers portion of the application process.
The Case Manager will assess admission necessity utilizing the IQ SI/IS criteria. Review date will be assigned. If treatment plan does not meet criteria, the UR nurse will refer case to attending physician. If no determination, the UR nurse will refer the case to the Medical Director.
The Case Manager will perform the initial IQ and clinical review, within one working day of admission and document in eCARE
The Case Manager will perform continued stay IQ and document in eCARE a concurrent review every 3 days or sooner if change in LOC or clinical status.
The Case Manager will review all Observation patients daily per P&P #8756-M 8.0
Prepares review sheets for all patients, Medi-cal, (via TAR) Medicare, IMS and cash as well as other financial classes.
Initiates discharge planning per Department standard. All payor sources are screened for high risk, high volume and problem prone patients.
Conducts interview with patients and significant others. Explores avenues of discharge planning.
Demonstrates a knowledge of human behavior and counseling skills as they relate to patient and staff needs.
Documents in eCare information and events as they occur. Maintain verbal and written communication with physician, staff, and family regarding discharge planning process. Notes signed (with name and title) and dated with each entry into the discharge planning record.
Implements innovative discharge planning when needs are out of the ordinary or resources unavailable. Utilizes insurance plan's case management for planning, if available.
Assists patients and families with information regarding social, economic and emotional aspects and makes necessary referral to social work, financial counseling or educational resources. Is a resources person to patients and families.
Assists physicians in transferring patients to other facilities. Coordinates exchange of information, records, transportation and notifications. Documents activities in Discharge Planning notes.
Educates medical and nursing staff on discharge planning for continuity of care. Lower level of care; i.e., role of HHC, SNF, REHAB, etc. Interprets Medi-care, Medi-Cal, IMS, private insurance and HMO's as they pertain to discharge planning.
Acts as a public relations person. Participates in meeting and inservices by outside providers. Network with others in the community.
Participates in and initiates case conferences. Attends rehabilitation rounds as indicated.
Assists in development of policies and procedures and documentation forms.
Completes activities related to Observation, one day stays, concurrent and retroactive TAR documentation.
Returns all telephone reviews to insurance companies within one working day.
Minimum Education: Knowledge necessary to obtain RN license in the state of California and current California RN license.
Minimum Experience: Three (3) to five (5) years experience in an acute care hospital setting preferred.
Preferred Skills and Abilities: Broad knowledge of Medicare, Medi-Cal and insurance guidelines. Good written and verbal communication skills.
NOTE: You must meet all elements of the job requirements noted above and complete the People Answers portion of the application process.