LVN Case Manager (UR Psych) - Full Time, Days (Culver City)
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About The Position
The Case Manager, UR is responsible for overseeing the daily operations of the assigned caseload. Ensures Medical Necessity for patient admission and concurrent stay at the short-term acute hospital level of care are met, utilizing the facility approved non-MD reviewer guidelines. Communicates as appropriate to the payer. Refers all cases not meeting MN for second level review. Ensures a safe and timely discharge / transition to the next appropriate level of care. Ensures timely escalation of unresolved care coordination issues to the appropriate level/entity. Enters delays in service and avoidable days regarding exceeded payer LOS variances. Communicates denials and physician related utilization management practices to immediate supervisor same day as identified. Keeps facility administration and CM Manager / Director of Utilization Management aware of any daily operational / physician related issues. Works closely with the facility Physician Advisor and Corporate. Works collaboratively with health care team, patients and families, administration and members of the Medical Staff. Responsible for active participation in daily weekday intra disciplinary patient rounding. Completes TAR for assigned Medi-Cal patient population/ obtains authorizations for managed care accounts and submits appeals for all denied cases. Maintains confidentiality of all information according to Hospital Policy and Procedure and legal and regulatory requirements. Reviews hospital admissions and continued stays in accordance with procedures, criteria, and standards approved by the medical staff. Identifies opportunities for improvement in the current processes and procedures. Escalates unresolved issues to direct supervisor of UM Facility Administrator per escalation process. Collaborates with Social Services, Clinical Team, patient and families to prepare patient's discharge planning needs. Oversees appropriate DC documentation. Works with Social Service to perform a variety of miscellaneous services, such as arranging for discharge or post-hospital plans, placement of patients in skilled nursing facilities or board an care homes.
