Case Manager Per Diem 10 hr. Shifts

KPC GLOBAL MEDICAL CENTERS•Menifee, CA

About The Position

Under general direction, the Case Manager coordinates a continuum of care for a selected group of patients from admission through discharge. The role helps patients and families proceed efficiently through hospitalization, moves patients through the hospital system in a cost-effective manner, and supports an optimal discharge plan. Responsibilities also include screening patients after admission, reviewing medical records on an ongoing basis for quality of care, maximizing reimbursement for services provided, and performing other assigned duties. The position requires a combination of appropriate education and experience that provides the necessary knowledge and abilities. An Associate of Science Degree in Nursing, a current California RN license, and current BLS certification are required. Two years of experience in utilization management, discharge planning, case management, or equivalent work is preferred, preferably in an acute hospital setting.

Requirements

Associate of Science Degree in Nursing.
Current California RN license.
Current BLS certification.
Two years of experience in utilization management, discharge planning, case management, or equivalent is preferred, preferably in an acute hospital setting.
Knowledge of InterQual guidelines.
Knowledge of payor-source documentation requirements and governmental regulations affecting reimbursement.
Knowledge of hospital nursing principles, methods, and commonly used medical procedures.
Knowledge of common patient disease processes and usual treatment methods.
Knowledge of medical terminology, hospital nursing facility routine, and commonly used equipment.
Knowledge of identifying potential discharge needs, community resources, hospital nursing facility organization, and the interrelationship of clinical and diagnostic services.
Ability to evaluate medical records for appropriateness of acute hospitalization based on intensity of service and severity of illness.
Ability to make recommendations about continued-stay necessity and appropriateness of level of care.
Ability to identify discharge needs, assess available resources, and formulate appropriate discharge plans.
Ability to communicate documentation needs in a cooperative manner.
Ability to gather and analyze data and prepare reports and recommendations.
Ability to work effectively with physicians, other health providers, outside payor sources, community resources, and the general public.
Ability to relate positively with patients and families and demonstrate crisis intervention skills.
Ability to collaborate with nursing personnel, physicians, and other health care professionals regarding the plan of care.
Ability to assess patient and family needs for post-discharge care and implement an efficient discharge plan.

Nice To Haves

Two years of experience in utilization management, discharge planning, case management, or equivalent, preferably in an acute hospital setting.

Responsibilities

Coordinate a continuum of care for selected patients from admission through discharge.
Screen patients after admission and conduct ongoing review of medical records pertaining to quality of care.
Help patients and families proceed efficiently through hospitalization and move patients through the hospital system in a cost-effective manner.
Maximize reimbursement for services provided.
Evaluate medical records to assess whether acute hospitalization is appropriate based on intensity of service and severity of illness.
Make recommendations regarding continued-stay necessity and appropriateness of the level of care.
Identify discharge needs and assess available resources to formulate an appropriate discharge plan.
Communicate documentation needs in a manner that promotes cooperation.
Gather and analyze data and prepare reports and recommendations.
Work effectively with physicians, other health providers, outside payor sources, community resources, and the general public.
Relate positively with patients and families and demonstrate crisis intervention skills.
Collaborate with nursing personnel, physicians, and other health care professionals regarding the plan of care.
Assess patient and family needs for post-discharge care.
Plan and implement a quality, efficient discharge plan that enables patients to function at their highest level of independence.
Perform other duties as assigned.