Care Management Specialist
4 days ago
**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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