Case Manager
3 weeks ago
Monitors the admissions, continued stay, and discharge of patients following pre-established criteria. Assures that patients meet InterQual criteria from admission to discharge including appropriateness of level of care. Conducts interdisciplinary care management rounds. Ensures collaboration between multidisciplinary healthcare team members, primary physician, community agencies, HMOs/PPOs, CCS, etc., whose services may be required and/or related to the care needs of the patient after hospital discharge. Monitors nursing and medical plans of care/discharge plans and provides appropriate interventions to assure care is appropriate, coordinated and that avoidable patient days are addressed effectively through education, consultation, and counseling as needed. Ensure patient centered discharge planning and assessment by communicating the appropriate discharge information and instructions to the primary care giver and primary physician and/or follow-up care agency. Assures patients are transferred to appropriate approved facilities when required.
This position requires providing service to an ill through rehabilitating neonatal through geriatric patient population in a manner that demonstrates an understanding of the functional/developmental age of the individual served.
This position requires the full understanding and active participation in fulfilling the Mission of San Gabriel Valley Medical Center. It is expected that the employee will demonstrate behavior consistent with the Core Values. The employee shall support San Gabriel Valley Medical Center’s strategic plan and the goals and direction of the Performance Improvement Plan (PIP)..
Responsibilities:
Discharge planning to occur with patient and family within two working days of admission and relay information to UR Staff.
Performs admission and continued stay review utilizing criteria approved by the medical staff to ensure that patients meet Severity of illness/intensity of Service criteria.
Confers with the attending/consulting physician(s) as appropriate when the medical necessity for admission or continued stay in not clear.
Consults with the Physician Advisor when the admission or continued stay does not meet criteria, care is not being provided timely or does not meet the community standard of care.
Provides clinical review information to external review entities or insurance companies to ensure authorization for admission and continued stay is obtained.
Accurately completes the MediCal Treatment Authorization Request (TAR) in detail to ensure payment for hospital services.
Refers medically complex patients under the age of 65 to the MediCal Case Management program.
Facilitates transfer of patients to other acute care facilities as required either due to third party payer requirements or county indigent program.
Identifies potentially avoidable days, delays in service, over utilization or quality of care issues and completes reports as required.
Performs the Case Management Admission Assessment within two working days of admission.
With the concurrence of the patient, family and physician develops a plan for post discharge care.
Refers appropriate patients to Social Services for psychosocial intervention, Advance Directive or end of life education.
Accurately documents the case management process in the medical record on the Discharge Planning Assessment form N-245.
Identifies the responsibilities and involvement of the Inter-disciplinary team members in discharge planning activities on an ongoing basis.
Participates in Interdisciplinary Care rounds/conferences to facilitate coordination of care, goal setting, and developing strategies to facilitate the discharge planning process.
Communicates the final discharge date and plan with the patient and family to ensure that they are informed as required by law and documents such notification in the Plan section of the Discharge Planning Assessment form (N-245).
Provides accurate information and completes referrals as appropriate to implement the discharge plan including but not limited to Home Health Services, Hospice, Skilled Nursing Facilities, Durable Medical Supplies, and other community resources.
Maintain confidentiality as required by HIPPA and only provides information relating to payment, hospital operations or continuity of care.
Provides “hand off” information to the receiving Case Manager to ensure a safe, smooth transition to other nursing units.
Refers situations requiring immediate intervention to the Director of Case Management, Risk Management, Director of Quality Management and the Vice President of Medical Affairs.
Participates in committee meetings, patient care conferences other activities as assigned.
Participates in department Performance Improvement activities.
Participates in the orientation of new employees or cross training other case managers as needed.
Maintains accurate records and statistics of case management activities, as required.
Demonstrates a continuing effort to improve the quality of case management performance through on-going education.
Incorporates the core values; dignity, collaboration, justice, stewardship and excellence into daily performance.
Performs other related duties as assigned or requested.
Qualifications:
Minimum Qualifications
Graduate of an accredited RN School of Nursing
Four years recent acute care experience in a critical care setting (preferred)
Two years Utilization Management/Case Management experience in an acute care setting (preferred)
Working knowledge of Interqual, Intensity of Service/Severity of Illness criteria.
Working knowledge of Title XVII and Title XIX.
Working knowledge of reimbursement related to Medicare, Medi-Cal, Capitation, and Managed Care is required.
Ability to negotiate orders with the physicians in order to assign alternate levels of care.
Working knowledge of community resources.
Working knowledge of methods to resolve patient needs such as discharge planning, Home Health, DME and SNF’s.
Ability to case manage smoothly and increase patient/physician satisfaction while staying within guidelines.
Ability to track outcomes and report findings.
Able to problem solve effectively.
Ability to use clinical knowledge to identify potential quality issues, delays in service, post-acute care needs required.
Must have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, positive personal influence and negotiation skills.
Must have strong clinical assessment and critical thinking skills necessary to provide utilization review/discharge planning services appropriate to patients with complex medical, emotional and social needs.
Licenses/Certifications
Current California RN License
Current BLS Card
Current MAB Certification (BMC) preferred
-
Case Manager Per Diem
2 weeks ago
San Gabriel, United States AHMC Healthcare Full timeOverview: Monitors the admissions, continued stay, and discharge of patients following pre-established criteria. Assures that patients meet InterQual criteria from admission to discharge including appropriateness of level of care. Conducts interdisciplinary care management rounds. Ensures collaboration between multidisciplinary healthcare team members,...
-
Telephonic Case Manager II
1 week ago
California, United States CorVel Corporation Full timeThe Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient's current...
-
Telephonic Nurse Case Manager
4 days ago
California, United States ICW Group Full timeAre you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver. We believe in hard work, a fun work environment, and embracing creativity that only comes about when talented people collaborate to develop solutions. Our mission is to create...
-
Telephonic Nurse Case Manager
4 days ago
California, United States ICW Group Full timeAre you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver. We believe in hard work, a fun work environment, and embracing creativity that only comes about when talented people collaborate to develop solutions. Our mission is to create...
-
RN Case Manager
2 days ago
San Antonio, United States UT Health San Antonio Full timeRN Case ManagerManages cases to enhance the quality of patient management and satisfaction. Promotes continuity of care and cost effectiveness through integrating functions of case management, utilization review and management, and discharge planning.
-
CA Telephonic Case Manager II
2 weeks ago
California, United States CorVel Corporation Full timeThe Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient's current...
-
Case Manager
1 week ago
San Diego, United States Oxford Health Group Full timeWe are looking for a talented **Case Manager** **for a homeless shelter place. If you are currently an employee $100 referral bonus for sharing your amazing work experience with your friend and getting them hired. **Come Join the team everyone is talking about!!!** #**Case Manager** **Horizon Repecurative Care** is a pillar for providing care to the...
-
Case Manager
2 weeks ago
San Diego, United States Metro Community Ministries Inc. Full time**Case Manager **will assess newly assigned participants to identify strengths and needs. Use assessment information to develop an individualized service plan. The case manager will work with individuals to create a plan of action to focus on credentialed training, job placement, and job retention strategies. The Case Manager will conduct ongoing assessment...
-
Case Manager
5 days ago
San Francisco, United States Family Service Agency San Francisco Full timeCase Manager Harbor Haven Supportive Housing Program Felton Institute Agency Overview Founded in 1889, the Felton Institute (formerly Family Service Agency of San Francisco) has a history of innovation in services for vulnerable children, families, and adults. Feltons mission is to respond to human needs with cutting edge social services and treatment that...
-
Case Manager
3 days ago
San Diego, United States Opus Health LLC Full timeThe Case Manager will work under the supervision of the Program Director. The Case Manager will perform client intake, sign all intake documents, and perform group and individual sessions. The Case Manager will perform duties while adhering to the organization's values and principals. EXPERIENCE & EDUCATION: A minimum of a High School diploma or GED is...
-
Case Manager
1 month ago
San Diego, United States Haitian Bridge Alliance Full timeJob DescriptionJob DescriptionSalary: 60,000About the OrganizationHaitian Bridge Alliance, Inc. (HBA) also known as “The BRIDGE” is a 501(c)(3) grassroots nonprofit community organization that advocates for fair and humane immigration policies and provides migrants and immigrants with humanitarian, legal, and social services, with a particular focus on...
-
Case Manager
1 month ago
San Diego, United States Opus Health Full timeJob DescriptionJob DescriptionThe Case Manager will work under the supervision of the Program Director. The Case Manager will perform client intake, sign all intake documents, and perform group and individual sessions. The Case Manager will perform duties while adhering to the organization's values and principals.EXPERIENCE & EDUCATION:A minimum of a...
-
RN Case Manager
3 weeks ago
San Diego, United States Rady Children's Hospital-San Diego Full timeJOB SUMMARY: Case Managers function as liaisons between patients, their families, and internal and external health care personnel to ensure appropriate, efficient, and timely health care service. Their focus includes providing clinical documentation to third party payers to facilitate authorization and reimbursement for inpatient hospital stays,...
-
Case Manager
5 days ago
San Diego, California, United States The E W Scripps Company Full timeThis is a Full-Time (70 hours per pay period) position with a day shift schedule on variable days of the week, including weekends and holidays. Located at Scripps Mercy Hospital San Diego - Hillcrest. Position is eligible for a $4,000 retention + $3,000 relocation bonus based off eligibility. Join the Scripps Health team and work alongside passionate...
-
Case Manager
4 days ago
San Diego, United States Marsell Wellness Center Full timeJob DescriptionJob DescriptionJOB descriptionJob Title:Case ManagerDepartment:Location:Family WellnessSan DiegoReports To:Lead Case ManagerFLSA Status:Salary: Non-ExemptStarting at $27.40Position Summary: The Case Manager will perform a full range of targeted and/or general case management that is strength-based, needs-based, community-based, and...
-
Case Manager
2 days ago
San Francisco, United States Insight Housing LLC Full timeCompensation: $28.32/hour *This SF position does not require a driver's license, vehicle, or insurance* Free Dental & Vision 19 Paid Holidays- Including 4 Mental Health Days (guaranteed paid holiday each month and most months a 3-day weekend! Retirement Plan with a match Paid Training 10-year anniversary sabbatical Flexible Spending Accounts Professional...
-
Case Manager
2 weeks ago
San Antonio, United States The HT Group Full timeLocation: San Antonio Type: Contract to Hire Job #18548 Salary: $23.07 USD The HT Group is partnering with a medical planning company in North San Antonio who is seeking a Case Manager to join their team on a temp-to-hire basis. The ideal candidate has experience in medical customer service, has excellent written and verbal communication skills, exceptional...
-
Lead Case Manager
1 month ago
San Pedro, United States Toberman Neighborhood Center, Inc. Full timeAt Toberman, we are committed to fostering a strong, healthy, and empowered community. Our center serves as a beacon of hope and support, offering a wide array of services tailored to meet the diverse needs of our community members. From educational programs to emergency assistance, our mission is to provide the resources and support needed to build...
-
California, United States Conduent Full timeA través de nuestros asociados, Conduent ofrece servicios y soluciones de misión crítica a empresas de Fortune 100 y más de 500 gobiernos, creando resultados excepcionales para nuestros clientes y los millones de personas que cuentan con ellos. Tienes la oportunidad de prosperar personalmente, marcar la diferencia y ser parte de una cultura donde la...
-
RN Case Manager
1 day ago
San Antonio, TX, United States UT Health San Antonio Full timeRN Case ManagerManages cases to enhance the quality of patient management and satisfaction. Promotes continuity of care and cost effectiveness through integrating functions of case management, utilization review and management, and discharge planning.
