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Case Management Coordinator
2 months ago
ScionHealth - Kindred Cornerstone & Solara Hospitals is seeking a skilled Registered Nurse Case Manager to join our team in Rancho Cucamonga, California.
Job SummaryUnder the supervision of the Director of Case Management, the Registered Nurse Case Manager will assist in enhancing the efficiency of the Case Management Department and support the daily functions of the Case Managers. This role will involve securing arrangements for discharge transitions and post-acute services, working with the Case Management team to monitor and obtain insurance verifications and concurrent authorizations, and assisting with denial prevention and management.
Key Responsibilities- Provide assistance to the Case Management staff, including creating and sending referral packets, organizing admission and discharge patient records, making phone calls, and obtaining signatures.
- Assist the Case Management team in scheduling family conferences and making necessary arrangements for post-discharge follow-up care.
- Function as the point of contact and liaison for the hospital Case Management department staff regarding clinical insurance review completion and/or issues.
- Monitor, follow-up, document, and track payer responses/requests of completed clinical reviews, including approvals, appeals, and denials, and communicate these to the appropriate individuals.
- Initiate and complete insurance pre-certification for patients lacking certification and communicate pre-authorization outcomes to appropriate individuals.
- Organize and prepare the necessary clerical elements for the weekly Interdisciplinary Team Meeting and other Case Management meetings.
- Must read, write, and speak fluent English.
- Must have good and regular attendance.
- Ability to learn logistics of insurance verification and certification process, case management, and discharge planning tasks.
- Clinical knowledge to read, interpret, and communicate information in the medical record that identifies diagnoses, treatment plans, interventions, and medical necessity for hospitalization.
- Knowledge of Medicare benefits and insurance processes and contracts.
- Knowledge of accreditation standards and compliance requirements.
- Excellent interpersonal, verbal, and written skills to communicate effectively and obtain cooperation/collaboration from hospital leadership, physicians, payers, and other external customers.
- Ability to work under stress, multitask, and respond quickly in urgent situations.
ScionHealth - Kindred Cornerstone & Solara Hospitals is a healthcare organization committed to providing quality-driven, patient-centered acute and post-acute hospital solutions in communities across the country. We strive to drive innovation and invest in people and technology to deliver compassionate patient care and excellent health outcomes in ways that lift a community and improve health equity.
