In Patient Nurse Case Manager
1 week ago
MedPOINT Management
Title: Inpatient Nurse - Delegated Plans =====================================================================================
MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmangement.com
Duties and Responsibilities for Delegated Plans:
1. Facilitates patient’s transfer to capped hospital when admitted to an out of network or out of capped facility and needs continued hospitalization. The nurse follows the Out of Network Transfer Protocol below:
a. The nurse calls the assigned hospitalist where the patient is to be transferred to and lets him/her know that the current attending physician will be calling to discuss continuation of care or vice-versa.
b. The nurse calls the capitated hospital to check if bed is available, provides patient’s demographic information and faxes a face-sheet or pertinent records to the hospital if requested.
c. The nurse checks if MD-to-MD has occurred and once confirmed that the hospitalist has accepted the patient’s transfer and if bed is available, the nurse generates a tracking number for the ambulance.
d. The nurse calls the facility where the patient is being transferred from in order to give the room number assigned for the patient, the phone number for the nurse’s station where the releasing hospital has to call for report and gives the authorization generated for the ambulance.
2. Facilitates Emergency Room (ER) transfers when patients require admission. The nurse assesses and verifies if the patient is stable for transfer to capped hospital, if stable will proceed to Step 1a. If unstable or no bed is available, the nurse gives authorization to admit the patient
3. Documents the specific reason/s why patient is not repatriated back into network or capped facility.
4. Verifies if the attending physician assigned on the case is the correct hospitalist. If assigned attending is not the correct hospitalist, the nurse switches the providers by calling the contracted hospitalist on the case, once accepted, the nurse informs the attending provider that IPA contracted hospitalist will be taking over the case. The nurse e-mails Provider Relations Department of the incorrect attending physician assignment for hospital ER and admitting staff education to ensure correct Hospitalist assignment on future admissions.
5. Coordinates transfers of patients to tertiary facilities for higher level of care.
6. Calls the hospital UR Department to request initial reviews, concurrent reviews and discharge planning for IPA members.
7. Documents clinical reviews in the EZ-cap system.
8. Assigns the appropriate Level of Care (LOC) and approves the authorization if deemed medically necessary using MCG or Inter-Qual (CareEnhance Review Manager Enterprise) guidelines.
9. Identifies unnecessary or aberrant days and forwards the information to the Medical Director and Inpatient UM Manager for final review and determination of potential denial of days.
10. Forwards the case to the Notice of Action (NOA) Coordinator for denial or modification letter generation if final determination is to DENY or modify continued stay. The nurse ensures that the case is closed accurately and documents on Memo Line #2 of EZ cap the number of approved and denied days i.e. Approved 2 days, denied 2 days.
11. Facilitates discharge planning to home, skilled nursing facility, hospice care, etc. Documents discharge disposition on the date of patient’s discharge.
12. Provides authorization for discharge needs i.e. home health care PT, OT, skilled nursing visits, Home infusion, Self-injectable drugs, DME, medical supplies, etc.
13. Reviews and documents clinical reviews of SNF patients at least weekly.
14. Forwards to Disenrollment Coordinator information of SNF patient who is admitted to long-term care and has resided in a nursing facility beyond 30 days. After the month of admission to facilitate disenrollment of member from Managed Care Medi-Cal back to Fee for Service Medi-Cal.
15. Provides authorization for inter-facility ambulance transfers.
16. Attends the daily inpatient meeting to go over daily bed day reports.
17. Reviews and maintains bed day logs weekly and monthly to ensure that Status 7 or pending/open cases are closed timely.
18. Refers potential re-admissions to Outpatient High Risk Case Management for follow-up post discharge.
19. Refers any potential quality of care issues (PQI) identified to the QI Department for review of QI cases.
-
Case Management Nurse
2 weeks ago
Los Angeles, United States Hollywood Home Health and Hospice Services Full timeCompany DescriptionHollywood Home Health & Hospice Services is a single source for skilled nursing dedicated to providing innovative, quality, and cost-effective home health services to home bound individuals. We prioritize the well-being and comfort of our patients and are committed to maintaining the highest standards of care. Our services are designed to...
-
HIV Nurse Case Manager
1 week ago
Los Angeles, United States To Help Everyone Health & Wellness Centers Full timeJob DescriptionJob DescriptionEssential Responsibilities and Duties:Conducts complete medical case management assessments for all assigned clients.Develops individualized nursing case management plan for each assigned client according to their health care needs.Performs Intake of all assigned clients into medical case management services following an agreed...
-
Registered Nurse Case Manager
3 days ago
Los Angeles, United States IMCS Group Full timeJob DescriptionJob DescriptionWe are seeking a Registered Nurse Case Manager to join our team! You will be responsible for the assessment, diagnosis, and treatment of assigned patients.Responsibilities:Administer nursing care to ill, injured, or disabled patientsDiagnose and establish patient treatment plansMonitor and report changes in patient symptoms...
-
Case Manager LVN
3 weeks ago
Los Angeles, United States Mission Community Hospital Full timeJob DescriptionJob DescriptionCase ManagerPOSITION SUMMARYAll employees are expected to perform their duties in alignment with the vision and values of the organization. The Case Manager is responsible for a variety of tasks that lead to a high level of customer satisfaction in the most cost-effective manner. Responsible for case management activities...
-
Home Health RN/LVN Nurse Case Manager
2 weeks ago
Los Angeles, United States Dynamic Nursing, Inc. Full timeJob DescriptionJob DescriptionOur dedicated, patient-focused Home Health agency is seeking a Home Health LVNorRN Nurse Office Case Manager to join our growing team! You will be responsible for the assessment, diagnosis, and treatment of assigned patients while collaborating with our patient facing field Nurses.REQUIREMENTS:New Grads WelcomeValid CA Nursing...
-
RN Case Manager
1 week ago
Los Angeles, United States American Nursing Home Health Full timeJob DescriptionJob Description A Medicare Certified home health agency seeking RN Case Manager with minimum of two (2) years of experience in healthcare setting. The candidate must have valid CA RN and / or BSN license. This is a full-time job with employee benefits. The candidate with home health care experience is a big plus. This is an immediate opening....
-
Remote RN Inpatient Case Manager, PST
3 weeks ago
Los Angeles, United States North American Staffing Group Full timeJob DescriptionJob DescriptionMedica Talent Group is excited to share this short term temp assignment opportunity with you!The RN Case Manager will provide daily care coordination with concurrent review for patient in the hospital or Skilled Nursing Facilities (SNF) in person or telephonically. This position will also provide case management to patients who...
-
RN Case Manager
Found in: beBee jobs US - 3 weeks ago
Los Angeles, California, United States Prospect Medical Holdings, Inc. Full timeThe RN Case Manager is responsible for performing clinical assessment and reassessment of acute care Inpatients for the purpose of performing utilization review, resource management and safe discharge planning. The RN Case Manager prioritizes, plans, organizes, and implements timeliness of care. Collaborates with the interdisciplinary healthcare team to...
-
Travel Nurse
Found in: Talent US A C2 - 3 days ago
Los Angeles, United States TLC Travel Staff Full timeTLC Travel Staff is seeking an experienced Case Manager Registered Nurse for an exciting Travel Nursing job in San Pedro, CA. Shift: 5x8 hr days Start Date: 05/20/2024 Duration: 13 weeks Pay: $2628.97 / Week Job Description: Position Type: Travel Nursing Specialty: NursingRN Case Manager Experience:Candidates must have a...
-
Travel Nurse
Found in: Talent US A C2 - 2 days ago
Los Angeles, United States TLC Travel Staff Full timeTLC Travel Staff is seeking an experienced Case Manager Registered Nurse for an exciting Travel Nursing job in San Pedro, CA. Shift: 5x8 hr days Start Date: 05/20/2024 Duration: 13 weeks Pay: $2630.26 / Week Job Description: Position Type: Travel Nursing Specialty: NursingRN Case Manager Experience:Candidates must have a...
-
Case Manager
3 weeks ago
Los Angeles, United States JWCH Institute Full timeJob DescriptionJob DescriptionPosition Purpose:The case manager provides comprehensive case management services to all eligible patients who are high utilizers of services, individuals and families experiencing homelessness, and adults with serious mental illness, and/or substance use disorders. Reporting to the Program Manager, the case manager will be...
-
Case Manager
1 week ago
Los Angeles, United States Orthopaedic Qualified Medical Evaluators Full timeJob DescriptionJob DescriptionOrthopaedic QME is a boutique, woman-owned medicolegal practice. We work with doctors, patients, and lawyers by providing a neutral and qualified medical expertise for workers compensation cases. We have a beautiful office in Marina del Rey, where you’ll work a Monday-Friday in-person shift. Hours are 8:30am-5pm.We’re...
-
Home Health LVN Case Manager
7 hours ago
Los Angeles, United States Choice Health Group Full timeJob DescriptionJob DescriptionSalary: $35-$40 DOEJoin Our Team at The Doctor's Choice Home Health!The Doctor's Choice Home Health is seeking immediate hire for an LVN Case Manager to join our growing team. The LVN will monitor the plan of care to reflect admission database, on-going findings, age-appropriate care, cultural specific needs, and...
-
Case Manager I
3 weeks ago
Los Angeles, United States Tarzana Treatment Center Full timeJob DescriptionJob DescriptionPOSITION SUMMARYSeeking a full-time employee as a Case Manager to work as part of multidisciplinary team for Enhanced Case Management. This program is designed to provide in-person, community-based case management and wraparound services to eligible Medi-Cal members with multiple chronic conditions. Duties include but are not...
-
Case Manager I
2 weeks ago
Los Angeles, United States Tarzana Treatment Center Full timeJob DescriptionJob DescriptionPOSITION SUMMARYSeeking a full-time employee as a Case Manager to work as part of multidisciplinary team for Enhanced Case Management. This program is designed to provide in-person, community-based case management and wraparound services to eligible Medi-Cal members with multiple chronic conditions. Duties include but are not...
-
Case Manager I
3 weeks ago
Los Angeles, United States Tarzana Treatment Center Full timeJob DescriptionJob DescriptionPosition Title: Case Manager IDepartment: MLKReports To: As assigned by Program DirectorPOSITION SUMMARYThe Martin Luther King Behavioral Health Center (MLK BHC) is a brand new, first of its kind , multi-agency facility centrally located in Wilmington! This facility is designed specifically to be a one stop location that will...
-
Case Manager I
3 weeks ago
Los Angeles, United States Tarzana Treatment Center Full timeJob DescriptionJob DescriptionPosition Title: Case Manager IDepartment: Community Supports- Housing Transition and NavigationReports To: As assigned by Program Senior Supervisor/DirectorPOSITION SUMMARYProvides case management services to members assigned to individual caseload. As a Housing Case Manager, Case Managers are expected provide high quality case...
-
LVN case manager
3 weeks ago
Los Angeles, United States Mission Community Hospital Full timeJob DescriptionJob DescriptionJob Summary:The LVN Case Manager at Mission Community Hospital in Panorama City, California will work as a full-time individual contributor, responsible for providing compassionate and high-quality care to patients while acting as a liaison between the patients, their families, and other healthcare professionals. This position...
-
Travel Nurse
Found in: beBee S US - 1 week ago
Los Angeles, United States Nomad Health Full timeNomad Health seeks an experienced Case Management registered nurse for a travel assignment in CA.Take the next step in your healthcare career and join Nomad Health as a Case Management travel nurse. As a traveler with Nomad, you get access to industry-leading pay, outstanding benefits, and our knowledgeable Nomad Navigator support team.QUALIFICATIONSMinimum...
-
Case Manager I
1 week ago
Los Angeles, United States Tarzana Treatment Center Full timeJob DescriptionJob DescriptionPosition Title: Case Manager IDepartment: All SitesReports To: As assigned by Program DirectorPOSITION SUMMARYProvides case management services to patients assigned to individual caseload.SALARY RANGE:$24.75 - $28.50 per hour DOEWe offer a competitive benefits package:Medical InsuranceDental InsuranceVision Care PlanLife...
