Inpatient Nurse Case Manager Coordinator
4 days ago
MedPOINT Management offers a challenging opportunity for an Inpatient Nurse Case Manager to join their team in the San Fernando Valley. This role involves facilitating patient transfers, coordinating care, and ensuring seamless transitions between healthcare settings.
The estimated salary for this position is $85,000 - $110,000 per year, depending on experience.
Responsibilities:
- Facilitate patient transfers to capped hospitals or tertiary facilities when necessary.
- Coordinate emergency room transfers and verify patient stability for transfer.
- Document reasons for non-repatriation of patients back into network or capped facilities.
- Verify attending physician assignments and switch providers as needed.
- Coordinate transfers to tertiary facilities for higher levels of care.
- Call hospital UR departments for initial reviews, concurrent reviews, and discharge planning.
- Assign Level of Care (LOC) and approve authorizations using MCG or Inter-Qual guidelines.
- Identify unnecessary or aberrant days and forward information to Medical Director and Inpatient UM Manager.
- Forward cases to Notice of Action (NOA) Coordinator for denial or modification letters.
- Facilitate discharge planning to home, skilled nursing facilities, hospice care, etc.
- Provide authorization for discharge needs, such as home health care, PT, OT, skilled nursing visits, etc.
- Review and document clinical reviews of SNF patients weekly.
- Forward information to Disenrollment Coordinator for SNF patients admitted to long-term care.
- Provide authorization for inter-facility ambulance transfers.
- Attend daily inpatient meetings to review bed day reports.
- Review and maintain bed day logs weekly and monthly.
- Refer potential re-admissions to Outpatient High Risk Case Management.
- Refer quality of care issues to QI Department for review.
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