RN Case Manager - Case Management
About The Position
Case Managers function as liaisons between patients, their families, payors, and healthcare personnel to ensure appropriate movement along the continuum of care. Their focus includes coordinating discharge needs, quality of care, and implementing the utilization management process for acute inpatients. Case Managers perform concurrent review and denials management based on acute care guidelines with a focus on authorization and reimbursement, appropriateness of admission, length of stay, and avoidable delays in discharge. The Case Manager collaborates with the family, the care team, third party payors, and outside providers to coordinate discharge needs including home health, durable medical equipment, and safe transitions of care.
Requirements
- BLS for Health Providers (American Heart Association)
- California RN License
- Bachelor's Degree in Nursing
- 4 years nursing in an acute hospital or 2 years Case Management, Utilization Review, or Discharge Planning experience in an acute hospital
Nice To Haves
- Experience in a pediatric acute hospital
- Familiarity with Interqual or Milliman Care Guidelines
- Experience navigating the electronic medical record (Epic)
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What This Job Offers
Job Type
Full-time
Number of Employees
1,001-5,000 employees
