RN Case Manager I
2 weeks ago
Sharp HealthCare is seeking a skilled RN Case Manager I to join our team. As a RN Case Manager I, you will play a critical role in ensuring that patients receive the highest quality care in the most efficient and cost-effective manner.
Key Responsibilities:- Assess, develop, implement, coordinate, and monitor comprehensive plans of care for patients and families in collaboration with physicians, social workers, and other members of the interdisciplinary team.
- Conduct initial reviews at point of entry or within 24 hours of admission, utilizing evidence-based care guidelines software to identify anticipated length of stay and document findings in the electronic medical record.
- Conduct daily concurrent reviews per protocol/policy and payer request, utilizing care guideline software to identify correct patient status and level of care.
- Work with attending providers to assure correct status and resolve conflicts, documenting interventions in the electronic medical record.
- Communicate with third-party payers to obtain necessary authorization for reimbursement of services and obtain approved days/length of stay from providers.
- Refer defined cases for medical secondary review and share findings with providers.
- Provide advice to Revenue Cycle/HIM regarding RAC decisions to appeal, denials, and input into appeals, sharing findings with providers.
- Review all cases with readmission within 30 days, reporting findings in the electronic medical record and in accordance with departmental policy.
- 2 years of recent acute care nursing experience, case management experience, or equivalent experience in the healthcare setting.
- California Registered Nurse (RN) licensure.
- Preferred qualifications include a Bachelor's Degree in Nursing or equivalent degree, Certified Case Manager (CCM) certification, and Accredited Case Manager (ACM) certification.
Sharp HealthCare is an equal opportunity/affirmative action employer. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.
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