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; and timely and accurate communication to insurance utilization review for certification of admission and continued stay. This role is for a results-driven leader ready to make a meaningful impact to patients, caregivers, and the community. At John F. Kennedy Memorial Hospital, we are seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.
Requirements
- Current license as a Registered Nurse in California, or related health care professional
- Three (3) years Case Management/UM experience in an acute care facility
- CPR
- Good communication skills and ability to work with others
- Basic computer skills
Nice To Haves
- Knowledge and experience with Medi-Cal
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
Senior
Education Level
High school or GED
