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

AHMC Healthcare•Monterey Park, CA

About The Position

The Case Manager uses InterQual criteria to evaluate the appropriateness of admissions, concurrent stays, and readiness for discharge, and assures the correct level of care for patients, including critical, telemetry, acute, and observation. The role provides an efficient, coordinated approach to clinical management, emphasizing discharge planning, care coordination, and utilization management for select patient populations across GMC’s programs and services. The Case Manager collaborates constantly with Social Workers, Nursing staff, Financial Counselors, and Medical Staff to coordinate patient care proactively. The position requires understanding and active participation in fulfilling the mission of GMC - Garfield Medical Center, demonstrating behavior consistent with its core values, and supporting its strategic plan, goals, and performance improvement plan.

Requirements

Current RN license in the State of California.
One year of Case Manager experience.
Current AHA BCLS certification.
Meet education and competency requirements for the position.

Nice To Haves

Certified Case Manager certification.

Responsibilities

Evaluate the appropriateness of admissions, concurrent stays, and readiness for discharge using InterQual criteria.
Assure the correct level of care for patients, including critical, telemetry, acute, and observation.
Coordinate clinical management, discharge planning, care coordination, and utilization management for select patient populations.
Collaborate with Social Workers, Nursing staff, Financial Counselors, and Medical Staff to coordinate care proactively.
Perform admission and continued-stay reviews using medical-staff-approved criteria to ensure patients meet Severity of Illness/Intensity of Service criteria.
Confer with attending or consulting physicians when medical necessity for admission or continued stay is unclear.
Consult with the Physician Advisor when admission or continued stay does not meet criteria, care is not provided timely, or care does not meet community standards.
Provide clinical review information to external review entities or insurance companies to obtain authorization for admissions and continued stays.
Complete Medi-Cal Treatment Authorization Requests (TARs) accurately and in detail to support payment for hospital services.
Refer medically complex patients under age 65 to the Medi-Cal Case Management program.
Facilitate patient transfers to other acute care facilities when required by third-party payer requirements or the county indigent program.
Identify potentially avoidable days, service delays, overutilization, or 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, or end-of-life education.
Document the case management process accurately in the medical record on the Discharge Planning Assessment form N-245.
Identify interdisciplinary team members’ responsibilities and involvement in discharge planning on an ongoing basis.
Participate in interdisciplinary care rounds and conferences to coordinate care, set goals, and develop strategies that facilitate discharge planning.
Communicate the final discharge date and plan to the patient and family, and document notification in the Plan section of the Discharge Planning Assessment form N-245.
Provide accurate information and complete referrals to implement discharge plans, including referrals for Home Health Services, Hospice, Skilled Nursing Facilities, Durable Medical Supplies, and community resources.
Perform other duties as assigned.
Treat internal and external customers with dignity and respect; communicate compassionately and effectively; respond efficiently to requests; and demonstrate professional behavior.
Support the Medical Center’s mission and strategic plan, participate in performance improvement activities, and complete required compliance education.
Follow applicable safety, fire safety, hazardous-material, emergency-assistance, equipment, infection-control, and contaminated-material procedures.
Provide care consistent with documented advance directives; comply with HIPAA, abuse-reporting requirements, National Patient Safety Goals, fall and wandering prevention, event reporting, sentinel-event procedures, and hospital disclosure policies.