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Clinical Care Coordinator
1 month ago
Job Summary:
We are seeking a skilled and compassionate RN Case Manager to join our team at MemorialCare Health System. As a key member of our Care Coordination department, you will play a vital role in ensuring the highest quality care for our patients and their families.
Responsibilities:
- Plan, coordinate, and facilitate the ongoing care and discharge planning for a specific caseload of patients through the continuum of care.
- Collaborate with the healthcare team, patient, and family to assure effective, efficient, and appropriate care and outcomes.
- Independently manage a specific case load of patients as identified by the Resource Management Department and CareLines.
- Analyze patient information and assess each patient's functional status and decision-making ability in relation to the continuum of care and discharge needs.
- Facilitate coordination among healthcare professionals, services, and settings involved in the patient's care, with a focus on enhancing patient satisfaction.
- Communicate effectively with nursing leadership, CareLine physician directors, and Medical Directors on quality issues.
- Maintain professionalism and provide ongoing education to the healthcare team regarding the case manager's role.
- Work collaboratively and proactively with payors in managing patient resources.
- Assure the hospital receives appropriate reimbursement through collaboration with the healthcare team and provides timely clinical review, as well as retroactive review for unbilled accounts.
Requirements:
- Current California RN License.
- BSN or Bachelors degree in health or related field preferred.
- Three to five years acute care or home health experience plus prior experience in Quality Improvement, Case Management, Discharge Planning or Utilization Management required.
- Strong verbal and written communication skills with the ability to communicate well with people from diverse socioeconomic backgrounds.
- Knowledge of criteria for medical necessity for each level of care through the continuum of care.
- Knowledge of reimbursement related to MediCare, MediCal, Capitation, and Managed Care.
What We Offer:
At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. We offer high-quality health insurance plan options, so you can select the best choice for your family. Check out our MemorialCare Benefits for more information about our Benefits and Rewards.
