Pediatric Case Manager Jobs

About The Position

Requirements

• Bachelor’s degree in a healthcare-related field.
• Recent experience in case management, utilization review, or discharge planning.
• Knowledge and abilities essential to successful performance of the assigned duties.
• Resourcefulness and superior written and oral communication, diplomacy, organizational, and analytical skills.
• Self-directed, assertive, and creative problem-solving, systems-planning, and patient-care-management abilities in a high-volume work environment.
• Basic computer skills.
• Ability to work effectively and collaboratively with interdisciplinary teams.
• Flexibility to orient and work at all UCSF Medical Center locations.
• California Registered Nurse (RN) license.

Nice To Haves

• Master’s degree in Nursing or a healthcare-related field.

Responsibilities

• Oversee and coordinate complex discharge planning for assigned patients with interdisciplinary team members, ensuring a safe discharge plan is developed and implemented in a timely manner.
• Review inpatients prospectively, concurrently, and retrospectively for appropriateness of admission and level of care, and determine appropriate length of stay.
• Collaborate with physicians, social workers, support liaisons, and other interdisciplinary team members to assess, plan, and coordinate patient care needs.
• Monitor length of stay and work with physicians to ensure resource utilization is within covered benefits and appropriate to patients’ clinical and psychosocial needs.
• Consider age-specific patient needs and communicate effectively with patients, families, staff, and community members from diverse backgrounds.
• Educate patients, families, and healthcare providers about utilization management and discharge planning options.
• Provide consultation and education to healthcare team members, hospital departments, service lines, community agencies, and providers.
• Perform utilization review using InterQual criteria for the assigned service line.
• Participate in denial review for the assigned service line.
• Liaise between insurance medical directors and attending physicians for peer-to-peer reviews of denied coverage.
• Provide clinical information requested by insurance organizations to support reimbursement.
• Participate in quality improvement activities, identify improvement opportunities, and contribute to clinical process improvement teams and concurrent data collection.
• Participate in departmental program planning, including goal setting, program development, and systems development and improvement; participate in work groups, committees, and task forces.
• Oversee and direct activities delegated to and performed by the Support Liaison.