Case Manager Jobs

About The Position

Requirements

• Associate of Science Degree in Nursing.
• Current California RN license.
• Current BLS certification.
• Two years of experience in utilization management, discharge planning, case management, or equivalent is preferred, preferably in an acute hospital setting.
• Knowledge of InterQual guidelines.
• Knowledge of payor-source documentation requirements and governmental regulations affecting reimbursement.
• Knowledge of hospital nursing principles, methods, and commonly used medical procedures.
• Knowledge of common patient disease processes and usual treatment methods.
• Knowledge of medical terminology, hospital nursing facility routine, and commonly used equipment.
• Knowledge of potential discharge needs, community resources, hospital nursing facility organization, and the interrelationship of clinical and diagnostic services.
• Ability to evaluate medical records, assess care needs and appropriateness, coordinate discharge planning, analyze data, communicate documentation needs, and work effectively with patients, families, healthcare professionals, payors, and community resources.
• A combination of appropriate education and experience that would likely provide the required knowledge and abilities.

Nice To Haves

• Two years of experience in utilization management, discharge planning, case management, or equivalent, preferably in an acute hospital setting.

Responsibilities

• Coordinate a continuum of care for selected patients from admission through discharge.
• Help patients and families proceed efficiently through hospitalization and move patients through the hospital system cost-effectively.
• Screen patients after admission and conduct ongoing reviews of medical records related to quality of care.
• Support reimbursement for services provided and develop optimal discharge plans.
• Evaluate medical records to assess the appropriateness of acute hospitalization based on intensity of service and severity of illness.
• Recommend whether continued stay is necessary and whether the level of care is appropriate.
• Identify discharge needs, assess available resources, and formulate appropriate discharge plans.
• Communicate documentation needs in a manner that promotes cooperation.
• Gather and analyze data and prepare reports and recommendations.
• Work effectively with physicians, other health providers, outside payors, community resources, and the general public.
• Relate positively with patients and families and demonstrate crisis intervention skills.
• Collaborate with nursing personnel, physicians, and other health professionals regarding the plan of care.
• Assess patient and family needs for post-discharge care and plan and implement quality, efficient discharge plans that enable patients to function at their highest level of independence.