Care Management Specialist

4 days ago


Oakland, California, United States Alameda Health System Full time

**Job Title:** Care Management Specialist

About the Role:

We are seeking an experienced Care Management Specialist to join our team at Alameda Health System. The successful candidate will coordinate continuum of care and discharge planning activities for a caseload of assigned patients, developing plans of care and discharge plans, monitoring all clinical activities, making recommendations for alternative levels of care, and identifying cost-effective protocols.

Responsibilities:

  • Coordinate all utilization review functions, including response to payor requests for concurrent and retrospective review information, applying Medical necessity criteria to determine level of care.
  • Assure clinical interventions are appropriate for the admitting diagnosis and Level of Care that reflects the standard of care, as defined by the medical staff and the organization.
  • Take appropriate action when cases do not meet criteria, escalating to the attending physician and Care Management physician advisor for determination.
  • Develop, evaluate, and coordinate a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social work, and other healthcare providers and agencies.
  • Identify potential problems, prevent and/or resolve barriers to the discharge plan.
  • Mobilize resources to effect rapid and timely movement of the patient through the system to achieve targeted discharge times established by AHS.
  • Collaborate with Care Management teams for high-risk patients for timely follow-up appointments and confirm prior to discharge that complex patients are appropriately linked to community services.

Requirements:

  • Active licensure as a Registered Nurse in the State of California.
  • Three years of acute care nursing experience.
  • Certification in Case Management, CCMC or ACM, preferred.
  • Bilingual, preferred.

Estimated Salary:** $90,000 - $110,000 per year.



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