Inpatient Case Manager

3 weeks ago


Orange, United States Prospect Medical Holdings Full time

Responsible for coordination of daily inpatient services including assessments, treatment planning, monitoring, evaluation, documentation and discharge planning function in accordance with Prospect Medical Group policies, procedure and processes. Interacts with the Medical Directors and hospitalists on a daily basis to determine necessity of continued stay.
- Effectively manage patients either telephonically or onsite during their hospitalization to ensure the appropriate level of care is provided for the patient’s severity of illness. Utilizes the appropriate tests and diagnostics in the right facilities to facilitate the highest level of care in the most efficient manner. Communicates effectively with facility staff and hospitalist to gather clinical information through verbal and written communications, and provides timely and accurate responses to request information or provide authorization decisions.
- Interacts with hospitalists and patients daily to evaluate plan of care including discharge planning to determine that patients are receiving quality care and appropriate discharge disposition. Applies medical knowledge to authorize outpatient services as an alternative to hospitalization when appropriate. Arranges for transfer to in-network care when appropriate.
- Updates clinical information in the electronic medical management record system with treatment plan, objectives, results and next steps. Documents all information accurately.
- Initiates and continues direct communication with health care providers involved with the care of the member, including the IPA or Hospitals Group if applicable, to obtain complete and accurate information. Applies appropriate benefits.
- Anticipates and initiates discharge planning within twenty four hours (24 hours) of admission, completes post discharge call within 24 hours to identify barriers and prevent readmission. Identifies post discharge care needs and refer to the appropriate outpatient programs and/or providers.
- Utilizes current approved criteria along with clinical experience to make authorization decisions. Identifies cases not meeting criteria and provides clinical information and rationale to the Medical Director for review and determination.
- Actively participates in daily rounds with current and accurate clinical information. Prepared to discuss current treatment plans from the Hospitalists or Specialists, plan of care for discharge disposition and continuity of care.
- Effectively manage an average census of 20-25 patients at any given time.
- May be required to take After Hours On-Call pager coverage as assigned.
- Refers cases to the Medical Director as appropriate for denial of stay or review of potential observation status.
- May be responsible for timely development of denial letter language and member/provider notification regarding Medical Director’s review determination.
- Identifies and refers cases appropriately for CCS, High Risk, Homebound, Hospice/Palliative, SNF, QI and Health Education, per policy, and documents referral in case file. Actively participates in internal quality and work flow enhancement projects, and other duties, as assigned. Identifies and reports departmental operational issues and resource needs to the appropriate identifies and reports under and over utilization of medical services, delays in service by provider or hospital or treatment and quality of care issues to the Medical Director.

**Qualifications**:
**Minimum Education**:High School graduate required; Associate in Arts degree preferred.

**Minimum Experience**:Three to five (3-5) years experience in a medical group or Health Plan setting with strong clinical skills and critical thinking. A t least 4 year’s of concurrent review experience, preferably in a managed care setting. Experience with Microsoft Office Word (50 WPM).

**Req. Certification/Licensure**:RN/LPN active unrestricted license required.

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by l



  • Orange, United States Regal Medical Group Full time

    Inpatient Case Manager (RN or LVN) #WDL-3094 Orange , CA Utilization/Quality Management Position Type Full-time Job Description Position Summary: The Inpatient Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode. Assesses and develops...


  • Orange, United States Prospect Medical Full time

    Responsible for coordination of daily inpatient services including assessments, treatment planning, monitoring, evaluation, documentation and discharge planning function in accordance with Prospect Medical Group policies, procedure and processes. Interacts with the Medical Directors and hospitalists on a daily basis to determine necessity of continued stay....


  • Orange Park, United States Becker Health Full time

    Manager of Case ManagementHCA Florida Orange Park HospitalFull Time - Days 7-10 Hrs/Weekdays Only Orange Park Medical Center is a full service, certified Level II Trauma Center with 300 plus inpatient beds located in the heart of Orange Park, FL and just outside of Jacksonville, FL. This state-of-the-art facility provides top-notch medical care to Clay...


  • Orange, United States Prospect Medical Holdings Full time

    This position supports the inpatient case manager to create a seamless transition for hospitalized patients and facilitate customer satisfaction. Documents in electronic medical record systems as directed. Focus should be on patient discharge from hospitals into lower level of care by providing the patient with community and alternative solutions. - Reviews...


  • West Orange, United States Spero Hospice Full time

    **Revised Job Description for a Hospice Nurse Case Manager in West Orange, NJ, US**:* **Join our team as a Hospice Nurse Case Manager in West Orange, NJ, US. You will enjoy a consistent patient load in the Northern New Jersey Area, with the majority of our patients receiving care in the comfort of their own homes. Additionally, we collaborate with inpatient...

  • Case Manager

    1 month ago


    Orange, United States ASTIVA HEALTH INC Full time

    **Job Title**: Case Manager **Target Compensation Range**: $100,000-$120,000/year, depending on level of relevant qualifications and experience. **About Us**: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our...


  • Orange, United States Center for Human Development Full time

    Case Manager- Outpatient Behavioral Health Services Orange, MA The Case Manager provides outreach and support to support incarcerated individuals who are engaged in the re-entry process to ensure they have the clinical and treatment supports necessary for success including medication assisted treatment, therapy, and other community services. Position...


  • Orange City, United States PAM Health Full time

    Job Description Job Description Director of Case Management (RN) The Director of Case Management is responsible for the coordination of the hospital-wide case management program. Oversees review of patient’s medical record to ensure proper utilization of hospital services. Assists case managers in providing timely coordination of care and discharge...


  • Orange City, United States PAM Health Full time

    Job DescriptionJob DescriptionDirector of Case Management (RN)The Director of Case Management is responsible for the coordination of the hospital-wide case management program. Oversees review of patient’s medical record to ensure proper utilization of hospital services. Assists case managers in providing timely coordination of care and discharge planning....


  • Orange City, United States PAM Health Full time

    Director of Case Management (RN)The Director of Case Management is responsible for the coordination of the hospital-wide case management program. Oversees review of patient's medical record to ensure proper utilization of hospital services. Assists case managers in providing timely coordination of care and discharge planning. Assures screening of all...

  • Case Manager

    1 month ago


    Orange, United States BM Healthcare Full time

    We have a contractual job as **Case Manager** for you in **Orange, CA**. If you are available in the job market. for new contract, please do let me know. **Contract Length : 13 Weeks** **Straight rate (Local) - $66hr on W2 (without stipend)** **Shift: Day 5x8-Hour (08:00 - 17:00)** **Job Type**: Contract Pay: $60.00 - $66.00 per hour Expected hours: 40...


  • Orange, United States Alta Hospitals Full time

    The scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members medical, environmental and...


  • Orange, United States Prospect Medical Holdings Full time

    The scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members' medical, environmental and...

  • Field Case Manager

    4 days ago


    Orange, United States Pivotal Placement Services Full time

    Field Case Manager (RN) This is a full-time permanent opportunity with a growing Case Management Company, which allows the nurse a lot more autonomy with their caseload with still the ability to bonus. We are looking for highly skilled, self-motivated, registered nurses (RN) who have experience with workers compensation nurse case management. Field Case...


  • Orange, United States Illumination Foundation Full time

    "Every person deserves compassion, dignity, and the safety of a place to call home."Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care...


  • Orange, United States Prospect Medical Holdings Full time

    Job DescriptionThe scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members' medical, environmental...


  • Orange, United States Alta Hospitals Full time

    The scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members’ medical, environmental and...


  • Orange, United States Prospect Medical Holdings Full time

    Job Description The scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members' medical,...


  • Orange, United States Jespy House Full time

    Job Purpose Under the supervision of the Residential/Community Based Supports Supervisor, the Case Manager serves individuals with learning, developmental and behavioral health disabilities through: direct support/case management; positive direction; and, advocacy in the community on behalf of and with the client. All are accomplished in accordance with...

  • Case Manager

    2 weeks ago


    Orange, United States American Veterans Aid Full time

    Seeking upbeat, driven individuals who are looking for a long-term position within a growing company. Our client service representatives provide valuable consultation to veterans and their families, regarding eligibility, supporting documentation, and long-term care planning. Duties & Responsibilities: Meeting and completing phone appointments with clients...