Transplant Case Manager
21 hours ago
Company Overview:
At MedPOINT Management, we are committed to providing exceptional healthcare services to our patients. As a Transplant Case Manager, you will play a vital role in ensuring the seamless coordination of transplant care for our patients.
Job Summary:
We are seeking an experienced RN or LVN to join our team as a Transplant Case Manager. In this role, you will be responsible for overseeing the higher level of care cases and transplant processes, providing guidance to inpatient nurses, and coordinating discharge planning for specified patient populations.
Responsibilities:
- Maintain updated lists of HLOC facilities for health plans and capped hospitals.
- Develop and maintain workflows for HLOC, transplant, and COC processes.
- Provide cheat sheets for go-to specialists and maintain lists of hospitals with special procedures.
- Oversee HLOC cases and inpatient transplant cases, ensuring clear communication and documentation.
- Obtain authorizations from individual health plans when needed and ensure condition codes are added for members requiring transplants.
- Submit LOAs for non-contracted providers and facilities when necessary.
- Assist Medical Directors as needed, referring potential readmissions and quality-of-care issues.
- Provide coverage as needed.
Requirements:
- Current RN or LVN licensure; Preferred: BSN level of education.
- Working knowledge of case management philosophy, principles of utilization review, quality assurance, and reimbursement structures.
- Ability to read, analyze complex clinical data, and apply it to level of care criteria and discharge options.
Salary: $85,000 - $110,000 per year, depending on experience.
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