RN Case Manager

Barstow Community Hospital • Barstow, CA

5d • $50 - $76

About The Position

The Case Manager is responsible for assessment and review of all admissions and concurrent review for continued hospitalization. The Case Manager reviews the medical record of patients to document admission justification and ongoing plan of care according to the Clinical Guidelines for Inpatient Care that justifies the admission and continued hospitalization of patients at Barstow Community Hospital. The Case Manager will provide timely utilization reviews as requested by third party payers. The Case Manager works closely with the Physician Advisor (PA) and refers all cases that do not meet acute level of care, any delays in service or treatment or long length of stays for review and action. The Case Manager is responsible for discharge assessments for all patients. The Case Manager works with a multidisciplinary team including the physician to assist patients and families transition from the acute level of care to a lower level of care. This discharge plan may include home health, SNF, board and care, custodial care and/or other community resources. The Case Manager will assess for resources management. The Case Manager will refer any quality issues to quality management and the Physician Advisor as issues are identified. The Case Manager will work closely with the business office to expedite insurance verification, authorization and payment.

Requirements

• Current Registered Nurse in the State of CA.
• BLS

Nice To Haves

• BSN Degree preferred.
• Inpatient and/or outpatient case management experience within the last year preferred.
• Discharge planning experience preferred.
• Quality review of patient care and retroactive review of patient records.
• Resource management experience desirable

Responsibilities

• Assessment and review of all admissions and concurrent review for continued hospitalization.
• Review medical records to document admission justification and ongoing plan of care.
• Provide timely utilization reviews as requested by third party payers.
• Refer cases not meeting acute level of care, delays in service/treatment, or long length of stays to the Physician Advisor.
• Conduct discharge assessments for all patients.
• Work with a multidisciplinary team to assist patients and families transition from acute care to a lower level of care.
• Assess for resources management.
• Refer quality issues to quality management and the Physician Advisor.
• Work with the business office to expedite insurance verification, authorization, and payment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level