Care Manager I (RN) - Per Diem : Irvine Care Management

Hoag•Irvine, CA

11d•Onsite

About The Position

The Care Manager (RN) for Utilization Review is responsible for evaluating inpatient admissions and ongoing hospital stays for medical necessity, appropriate level of care, and regulatory compliance. This role collaborates with physicians, physician advisors, coding, and interdisciplinary teams to ensure accurate patient status determinations and documentation that supports reimbursement and quality outcomes. The Care Manager (RN) coordinate patients’ needs through the continuum of care which can include from pre-admission through post discharge plans. This role works in collaboration with the physicians, nurses, clinical staff, and community agencies to identify and arrange for appropriate care. Reviews clinician assessments and patients’ financial, family and psychosocial support to develop comprehensive care and/or discharge plans. May focus more heavily on a specific aspect of Care Management like discharge planning, utilization review, and/or providing psychosocial support. May review records to assess for appropriate admission status, level of care, payer source, and UR contracts to validate billing. May provide psychodynamic intervention and crisis counseling to support patients and families. Educates patients and families on their healthcare options and connects them with resources. Documents pertinent patient issues, contacts and plans on the medical records. Is a mandated reporter for elder, child, and spousal abuse. The Community Care role specifically provides Care Management support to high-risk, homeless and mental health population. Performs other duties as assigned.

Requirements

Registered Nurse (RN) license
Experience in Utilization Review
Ability to collaborate with physicians, physician advisors, coding, and interdisciplinary teams
Knowledge of patient status determinations and documentation for reimbursement and quality outcomes
Experience coordinating patient needs through the continuum of care
Ability to work with physicians, nurses, clinical staff, and community agencies
Skills in reviewing clinician assessments and patients’ financial, family, and psychosocial support
Ability to develop comprehensive care and/or discharge plans
Experience in discharge planning, utilization review, and/or providing psychosocial support
Ability to review records for admission status, level of care, payer source, and UR contracts
Experience in providing psychodynamic intervention and crisis counseling
Ability to educate patients and families on healthcare options and connect them with resources
Proficiency in documenting patient issues, contacts, and plans on medical records
Understanding of mandated reporter responsibilities for elder, child, and spousal abuse
Experience providing Care Management support to high-risk, homeless, and mental health populations

Responsibilities

Evaluating inpatient admissions and ongoing hospital stays for medical necessity, appropriate level of care, and regulatory compliance.
Collaborating with physicians, physician advisors, coding, and interdisciplinary teams to ensure accurate patient status determinations and documentation that supports reimbursement and quality outcomes.
Coordinating patients’ needs through the continuum of care, from pre-admission through post-discharge plans.
Working in collaboration with physicians, nurses, clinical staff, and community agencies to identify and arrange for appropriate care.
Reviewing clinician assessments and patients’ financial, family and psychosocial support to develop comprehensive care and/or discharge plans.
Focusing on specific aspects of Care Management such as discharge planning, utilization review, and/or providing psychosocial support.
Reviewing records to assess for appropriate admission status, level of care, payer source, and UR contracts to validate billing.
Providing psychodynamic intervention and crisis counseling to support patients and families.
Educating patients and families on their healthcare options and connecting them with resources.
Documenting pertinent patient issues, contacts, and plans on the medical records.
Acting as a mandated reporter for elder, child, and spousal abuse.
Providing Care Management support to high-risk, homeless, and mental health populations.
Performing other duties as assigned.