ED UR Case Manager II

5 days ago

Escondido, United States Palomar Health Full time

Requisition ID 38943 Department Clinical Resource Management Location Escondido, California Union CNA Salary Range 47.17 - 68.67 Job Type Part-Time Shift Night Hours Per Shift 10 Hours Per Pay Period 40 Position at Palomar Health Description Responsible for implementing the utilization management process for patients admitted to the acute level of care and coordinating clinical case management and discharge planning for the Emergency Department patients based on acute care guidelines/standards with focus on appropriateness of admission, level of care, and discharge. Provides telephonic or fax reviews to multiple health plans/medical groups. Collaborates with the health care team in the development, implementation, and documentation of an appropriate safe care plan. Provides retro-review of identified cases denied by health plans for financial reimbursement. Participates in appeals process to recover fluids for services rendered by Palomar Health and ensures that patients/families understand their rights to appeal when they disagree with a medical determination. Analyzes and identifies utilization patterns and trends and participates in utilization monitoring activities. Coordinates appropriate, safe discharge plan with patients/families and in consultation/collaboration with health plan providers and internal as well as community resources. Obtains authorizations needed to implement appropriate care plan and assure financial reimbursement for care services. Understands effect of health care management and reimbursement on both patients and health care system. Accurately documents the care plan in the patient chart and communicates plan to patients/families. Maintains ongoing education/knowledge of case management and utilization concepts, State and Federal health care programs, changes in health care law, criteria for multiple levels of care; utilization process related to criteria for acute care admission and impact on health care system; and never ending changes in delivery of health care. Applies Case Management principles and strategies in the planning process. Receives ongoing education related to managed care organizations, preferred provider health plans, workers compensation plans, private health plans and third party payers. Functions as a key resource provider related to health care management, delivery of care, and effects or reimbursements on both patients and health care system. Performs other assigned duties. Understands and adheres to the California Nurse Practice Act, The American Nurses Association (ANA) Code of Ethics for Nurses, the ANA Bill of Rights for Registered Nurses and the ANA Scope and Standards of Practice for Nursing. Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.Job RequirementsMinimum Education: As required by certification and/or licensurePreferred Education: Bachelor's Degree and/or National Certification in Case Management and/or Utilization ReviewMinimum Experience: 1 - 3 years of directly related RN experiencePreferred Experience: 3 - 5 years acute care nursing experienceCompletion of Utilization Review/Case Management courseRequired Certification: American Heart Association recognized BLS - Healthcare ProviderPreferred Certification: Not ApplicableRequired License: Current CA RN LicensePreferred License: Not Applicable Current employees are not eligible for hiring incentives. We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status or any other characteristic protected by law.

  • Case Manager

    4 days ago

    Escondido, United States Marsell Wellness Center Full time

    **Job Title**: - Case Manager **Department**: **Location**: - Family Wellness - Escondido **Reports To**: - Lead Case Manager **FLSA Status**: **Salary**: - Non-Exempt - Starting at_ $57,000 **Position Summary**:The Case Manager will perform a full range of targeted and/or general case management that is strength-based, needs-based, community-based,...

  • Case Manager

    3 weeks ago

    Escondido, United States Interfaith Community Services Full time

    Description: **SHIFT: Monday - Friday 8am-5pm** **WHAT YOU WILL DO**:The Case Manager position will provide direct services to clients, to include but not limited to, intake, assessment and case management, and client advocacy (resources and referrals) to homeless and low-income individuals, with the goal of moving clients from crisis to self-sufficiency...

  • Case Manager

    1 month ago

    Escondido, United States Marsell Wellness Center Full time

    Job DescriptionJob DescriptionJob Title:Case ManagerDepartment:Location:Family WellnessEscondidoReports To:Lead Case ManagerFLSA Status:Salary: Non-ExemptStarting at $57,000Position Summary: The Case Manager will perform a full range of targeted and/or general case management that is strength-based, needs-based, community-based, and family-driven. The Case...

  • Case Manager

    4 weeks ago

    Escondido, United States Marsell Wellness Center Full time

    Job DescriptionJob DescriptionJob Title:Case ManagerDepartment:Location:Family WellnessEscondidoReports To:Lead Case ManagerFLSA Status:Salary: Non-ExemptStarting at $57,000Position Summary: The Case Manager will perform a full range of targeted and/or general case management that is strength-based, needs-based, community-based, and family-driven. The Case...

  • Case Manager

    2 months ago

    Escondido, United States DSSI, Inc. Full time

    DSSI is hiring Case Managers to work with a workforce services company in the Escondido area. This role focuses on helping individuals address any barriers they are facing by navigating them through their benefits and resources. **Details**: - Workdays: Monday-Friday - Work Hours: 8am-5pm **Duties**: - Meets with participants to identify barriers and...

  • Case Manager

    4 days ago

    Escondido, United States DSSI, Inc. Full time

    DSSI is hiring Case Managers to work with a workforce services company in the Escondido area. This role focuses on helping individuals address any barriers they are facing by navigating them through their benefits and resources. **Details**: - Workdays: Monday-Friday - Work Hours: 8am-5pm **Duties**: - Meets with participants to identify barriers and...

  • Case Manager

    4 weeks ago

    Escondido, United States Interfaith Community Services Full time

    Job DescriptionJob DescriptionDescription:SHIFT: Tuesday- Saturday 10am-7pmOVERVIEW: Founded in 1979 in direct response to rising rates of hunger and homelessness in North San Diego County, Interfaith Community Services works to break the cycle of poverty and homelessness by Helping People Help Themselves. Interfaith is the most comprehensive nonprofit...

  • Entry Level Account Manager

    3 days ago

    Escondido, United States San Diego Telecom Services Full time

    When you’re part of ur team, you’ll have the opportunity or contin - growth and lea - ng in a culture - t empowers your - elopment. We - the leading tel communica - ns firm right in - e heart of San Die , CA. When you join our try Level Account Manager team, you'll soon discover that every day is different because it is filled with new, exciting,...

  • Case Manager

    4 weeks ago

    Escondido, United States Redwood Terrace - a HumanGood community Full time

    Under limited supervision, the Care Case Manager helps post-acute patients and their families to navigate the skilled nursing rehabilitation experience.  Coordinates with interdisciplinary team including nurses, therapists, and physicians regarding discharge planning.  Serves as liaison with managed care partners and communicates with patients about...

  • Case Manager

    4 weeks ago

    Escondido, United States Redwood Terrace - a HumanGood community Full time

    Under limited supervision, the Care Case Manager helps post-acute patients and their families to navigate the skilled nursing rehabilitation experience.  Coordinates with interdisciplinary team including nurses, therapists, and physicians regarding discharge planning.  Serves as liaison with managed care partners and communicates with patients about...

  • Case Manager

    1 week ago

    Escondido, California, United States HumanGood Full time

    Under limited supervision, the Care Case Manager helps post-acute patients and their families to navigate the skilled nursing rehabilitation experience. Coordinates with interdisciplinary team including nurses, therapists, and physicians regarding discharge planning. Serves as liaison with managed care partners and communicates with patients about insurance...

  • Case Manager

    3 weeks ago

    Escondido, United States Interfaith Community Services Full time

    Job DescriptionJob DescriptionDescription:SHIFT: Tuesday- Saturday 10am-7pmOVERVIEW: Founded in 1979 in direct response to rising rates of hunger and homelessness in North San Diego County, Interfaith Community Services works to break the cycle of poverty and homelessness by Helping People Help Themselves. Interfaith is the most comprehensive nonprofit...

  • Experienced Case Manager

    2 months ago

    Escondido, United States DSSI, Inc. Full time

    DSSI is hiring Experienced Case Managers to work with a workforce services company in the Escondido area. This is a temporary role assisting on a special project aiming to help those currently facing a housing crisis. **Details**: - Workdays: Monday-Friday - Work Hours: 8am-5pm - Pay: $27/HR - Start: ASAP **Duties**: - Meets with participants to identify...

  • Case Manager

    1 week ago

    Escondido, California, United States Interfaith Community Services Full time

    Job Title: Service Coordinator at Interfaith Community Services SHIFT: - Tuesday- Saturday 10am-7pm ABOUT US: - Established in 1979 to address the increasing rates of hunger and homelessness in North San Diego County, Interfaith Community Services is dedicated to breaking the cycle of poverty and homelessness by empowering individuals to help themselves....

  • Experienced Case Manager

    1 week ago

    Escondido, California, United States DSSI, Inc. Full time

    DSSI is hiring Experienced Case Managers to work with a workforce services company in the Escondido area. This is a temporary role assisting on a special project aiming to help those currently facing a housing crisis.Details: Workdays: Monday-FridayWork Hours: 8am-5pm Pay: $27/HR Start: ASAPDuties: Meets with participants to identify barriers and challenges...

  • Site Manager Ii

    2 weeks ago

    Escondido, United States PSSI Full time

    Para ver la descripcion de trabajo en espanol, por favor desplacese hacia abajo hasta el final de la pagina.*** The Site Manager II performs exempt executive work such as supervising and directing the work of the sanitation crew, managing the budget (e.g., payroll, supplies, etc.), and billing our customers for services rendered. The primary duty entails...

  • Program Director I/II

    3 weeks ago

    Escondido, United States Health Right 360 Full time

    Job DescriptionJob DescriptionHealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment. HealthRIGHT 360 offers residential treatment services designed to serve individuals and...

  • Case Manager

    4 weeks ago

    Escondido, United States Palomar Health Rehabilitation Institute Full time

    **Description** A career at Palomar Rehabilitation Institute, a 52-bed inpatient acute rehabilitation hospital operated jointly with Lifepoint Health and Palomar Health, is more than a job. It's a chance to be a vital member of an interdisciplinary team caring for people in the San Diego area who need continued care to recover completely. You have...

  • Case Manager

    1 week ago

    Escondido, United States Palomar Health Rehabilitation Institute Full time

    **Description** A career at Palomar Rehabilitation Institute, a 52-bed inpatient acute rehabilitation hospital operated jointly with Lifepoint Health and Palomar Health, is more than a job. It's a chance to be a vital member of an interdisciplinary team caring for people in the San Diego area who need continued care to recover completely. You have...

  • Case Manager Employment Specialist

    1 week ago

    Escondido, California, United States Telecare Corporation Full time

    Case Manager Employment Specialist - Care Court ACT 624 CA State Governor's New Plan to Get California's in Crisis Off the Streets and into Housing, Treatment & Care * Community Assistance, Recovery and Empowerment (CARE) Court is a new framework to get people with mental health and substance use disorders the support and care they need. * CARE Court is...