Registered Nurse Case Manager (RN)
About The Position
The scope of duties encompasses a variety of tasks related to performing integrated concurrent review for utilization, quality and risk, discharge planning, and case referrals for patients. This position works with medical and professional staffs to obtain appropriate clinical documentation for review and to meet inpatient criteria by the Interqual Guidelines. The Case Managers are responsible for the research and appeal UR denials; micro management of patients to ensure appropriate and timely resource utilization; timely and accurate communication to insurance utilization review for certification of admission and continued stay. At John F. Kennedy Memorial Hospital hospital, we’re seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success. Desert Care Network serves the healthcare needs of the Coachella Valley and Morongo Basin regions in Southern California with three hospitals Desert Regional Medical Center in Palm Springs, JFK Memorial Hospital in Indio and Hi-Desert Medical Center in Joshua Tree. The hospital network provides advanced care with services such as comprehensive stroke care, a cancer center, a Level 1 Trauma Center and the only Level 3 Neonatal Intensive Care Unit (NICU) in the Coachella Valley. Desert Care Network is committed to healthcare equality. Join our team!
Requirements
- Registered Nurse Case Manager (RN)
Responsibilities
- Performing integrated concurrent review for utilization, quality and risk
- Discharge planning
- Case referrals for patients
- Working with medical and professional staffs to obtain appropriate clinical documentation for review and to meet inpatient criteria by the Interqual Guidelines
- Research and appeal UR denials
- Micro management of patients to ensure appropriate and timely resource utilization
- Timely and accurate communication to insurance utilization review for certification of admission and continued stay
Benefits
- Medical, dental, vision, and life insurance
- 401(k) retirement savings plan with employer match
- Generous paid time off
- Career development and continuing education opportunities
- Health savings accounts, healthcare & dependent flexible spending accounts
- Employee Assistance program, Employee discount program
- Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
