Clinical Case Coordinator
3 days ago
MarinHealth is an integrated and independent healthcare system with a commitment to innovation and excellence in patient care. We are dedicated to providing a comprehensive range of services through our network of clinics and our state-of-the-art medical center. Our organization is recognized for its high-quality care and has received numerous accolades, reflecting our commitment to the health and well-being of our community.
What We Provide
At MarinHealth, we offer a competitive benefits package designed to support the health, wellness, and financial security of our employees. Our offerings include health and fitness programs, retirement plans, life insurance, and generous leave policies. We strive to create a workplace that values the contributions of our staff and promotes a healthy work-life balance.
POSITION SUMMARY:
The Clinical Case Coordinator is responsible for conducting comprehensive reviews of patient admissions, ongoing care, and post-discharge processes for designated health plans. This role involves the application of standardized criteria to assess clinical stability and facilitate appropriate transitions of care. The Coordinator will also manage appeals for medical necessity denials and ensure that all documentation meets the required standards.
POSITION REQUIREMENTS:
EDUCATION
A Bachelor of Science in Nursing is preferred.
EXPERIENCE
- A minimum of three years in an acute care environment, preferably in medical/surgical or critical care settings.
- Significant experience in utilization review and discharge planning is highly desirable.
- Proficiency in case management software and evidence-based criteria application is essential.
- Strong communication and interpersonal skills, with the ability to resolve conflicts and negotiate effectively.
- Ability to work independently, prioritize tasks, and manage a high-volume caseload.
- Attention to detail and accuracy in documentation and patient assessments.
- Familiarity with current medical treatment protocols and relevant regulations.
- Understanding of insurance benefits and reimbursement processes.
- Knowledge of community resources and healthcare services available to patients.
- Current California RN license is required.
- BLS certification is mandatory.
- National certification in Case Management is preferred.
Utilization Review
- Conducts admission reviews and documents findings promptly.
- Assesses ongoing patient care needs and verifies treatment plans.
- Collaborates with healthcare teams to ensure efficient patient transitions.
- Reviews and manages appeals for medical necessity denials.
- Works with medical directors to resolve complex cases.
- Tracks and reports on the status of appeals and denials.
- Participates in departmental meetings and contributes to process improvements.
- Supports the development of training programs for staff.
- Maintains accurate patient records in compliance with regulations.
The compensation for this role will be determined based on the candidate's qualifications and experience, in alignment with our compensation philosophy.
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