Case Manager PD 10HR Days 7:30am-6pm

AHMC Healthcare•Monterey Park, CA

About The Position

The Case Manager uses InterQual criteria and criteria approved by the medical staff to evaluate admission appropriateness, continued stay, level of care, and readiness for discharge. The role provides coordinated clinical management for select patient populations across GMC programs and services, with an emphasis on discharge planning, care coordination, and utilization management. The Case Manager collaborates with Social Workers, Nursing staff, Financial Counselors, and Medical staff to coordinate patient care proactively. The position requires understanding and active participation in the mission, core values, strategic plan, goals, and performance improvement plan of GMC - Garfield Medical Center. The employee is expected to demonstrate professional, respectful, compassionate, responsive, adaptable, and safety-conscious behavior; fulfill compliance education requirements; and perform other duties as assigned.

Requirements

Current California RN license.
One year of Case Manager experience.
BLS (AHA) certification.
Meets education and competency requirements for the position.

Nice To Haves

Certified Case Manager.

Responsibilities

Evaluate admissions and continued stays using InterQual and medical-staff-approved criteria to ensure appropriate level of care and medical necessity.
Consult attending or consulting physicians when medical necessity for admission or continued stay is unclear; consult the Physician Advisor when criteria are not met or care is delayed or below community standards.
Provide clinical review information to external review entities and insurance companies to obtain admission and continued-stay authorization.
Complete Medi-Cal Treatment Authorization Requests (TARs) accurately and refer medically complex patients under age 65 to the Medi-Cal Case Management program.
Facilitate transfers to other acute care facilities when required by payer requirements or county indigent programs.
Identify potentially avoidable days, service delays, overutilization, and quality-of-care issues, and complete required reports.
Complete the Case Management Admission Assessment within two working days of admission.
Develop a post-discharge care plan with the concurrence of the patient, family, and physician.
Refer appropriate patients to Social Services for psychosocial intervention, advance directive support, or end-of-life education.
Document case management in the medical record using the Discharge Planning Assessment form N-245.
Identify and coordinate the responsibilities of interdisciplinary team members in discharge planning.
Participate in interdisciplinary care rounds and conferences to coordinate care, establish goals, and develop discharge-planning strategies.
Communicate the final discharge date and plan to the patient and family, and document notification in the Discharge Planning Assessment form N-245.
Provide accurate information and complete referrals to implement discharge plans, including referrals for home health, hospice, skilled nursing facilities, durable medical supplies, and community resources.
Support GMC's mission, strategic plan, performance improvement activities, and compliance requirements.
Provide respectful, compassionate, clear, and timely service to internal and external customers; respond to requests and assist others as needed.
Follow patient safety, infection prevention, hazardous-material handling, emergency-response, fire-safety, equipment-safety, HIPAA, advance-directive, abuse-reporting, and event-reporting requirements.
Attend classes, seminars, or on-the-job training to improve performance and service.
Perform other duties as assigned.