ED UR Case Manager II
2 weeks ago
Requisition ID 37567 Department Clinical Resource Management Location Escondido, California Union CNA Salary Range 47.17 - 68.67 Job Type Part-Time Shift Night Hours Per Shift 8 Hours Per Pay Period 45 Position at Palomar Health Description Responsible for implementing the utilization management process for patients admitted to the acute level of care and coordinating clinical case management and discharge planning for the Emergency Department patients based on acute care guidelines/standards with focus on appropriateness of admission, level of care, and discharge. Provides telephonic or fax reviews to multiple health plans/medical groups. Collaborates with the health care team in the development, implementation, and documentation of an appropriate safe care plan. Provides retro-review of identified cases denied by health plans for financial reimbursement. Participates in appeals process to recover fluids for services rendered by Palomar Health and ensures that patients/families understand their rights to appeal when they disagree with a medical determination. Analyzes and identifies utilization patterns and trends and participates in utilization monitoring activities. Coordinates appropriate, safe discharge plan with patients/families and in consultation/collaboration with health plan providers and internal as well as community resources. Obtains authorizations needed to implement appropriate care plan and assure financial reimbursement for care services. Understands effect of health care management and reimbursement on both patients and health care system. Accurately documents the care plan in the patient chart and communicates plan to patients/families. Maintains ongoing education/knowledge of case management and utilization concepts, State and Federal health care programs, changes in health care law, criteria for multiple levels of care; utilization process related to criteria for acute care admission and impact on health care system; and never ending changes in delivery of health care. Applies Case Management principles and strategies in the planning process. Receives ongoing education related to managed care organizations, preferred provider health plans, workers compensation plans, private health plans and third party payers. Functions as a key resource provider related to health care management, delivery of care, and effects or reimbursements on both patients and health care system. Performs other assigned duties. Understands and adheres to the California Nurse Practice Act, The American Nurses Association (ANA) Code of Ethics for Nurses, the ANA Bill of Rights for Registered Nurses and the ANA Scope and Standards of Practice for Nursing. Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.Job RequirementsMinimum Education: As required by certification and/or licensurePreferred Education: Bachelor's Degree and/or National Certification in Case Management and/or Utilization ReviewMinimum Experience: 1 - 3 years of directly related RN experiencePreferred Experience: 3 - 5 years acute care nursing experienceCompletion of Utilization Review/Case Management courseRequired Certification: American Heart Association recognized BLS - Healthcare ProviderPreferred Certification: Not ApplicableRequired License: Current CA RN LicensePreferred License: Not Applicable Current employees are not eligible for hiring incentives. We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status or any other characteristic protected by law.
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ED UR Case Manager II
2 weeks ago
Escondido, United States Palomar Health Full timeResponsible for implementing the utilization management process for patients admitted to the acute level of care and coordinating clinical case management and discharge planning for the Emergency Department patients based on acute care guidelines/standards with focus on appropriateness of admission, level of care, and discharge. Provides telephonic or fax...
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Utilization Review Case Manager
1 month ago
Escondido, United States Palomar Health Full timeRequisition ID 37398 Department Clinical Resource Management Location Escondido, California Union CNA Salary Range 47.17 - 68.67 Job Type Per Diem Shift Day Hours Per Shift 8 Hours Per Pay Period 0 Position at Palomar Health Description Responsible for implementing the utilization management process for patients admitted to acute level of care....
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Case Manager
1 week ago
Escondido, United States Mental Health Systems, Inc. Full timeJob DescriptionJob DescriptionAt TURN our mission is Improving Lives. Our organization embraces the tenets of client-centered care, and our core values Integrity, Diversity, Mentorship, and Inclusion are at the forefront of everything we do. We hire exceptional individuals seeking meaningful opportunities in a purpose-driven environment. JOB SUMMARYRecommend...
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Care Case Manager
4 weeks ago
Escondido, United States Mental Health Systems, Inc. Full timeAt TURN our mission is Improving Lives. Our organization embraces the tenets of client-centered care, and our core values Integrity, Diversity, Mentorship, and Inclusion are at the forefront of everything we do. We hire exceptional individuals seeking meaningful opportunities in a purpose-driven environment. JOB SUMMARY Recommend and assist access to...
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Home Health Registered Nurse
1 month ago
Escondido, United States Archer Health, Inc Full time**Job description** Are you looking for a calling, a passion, a job/career where you can make a difference?We are looking for Registered Nurse Case Manager. We will offer Health Insurance Dental & vision 401k Paid training Paid sick time Opportunity to grow Great company culture Archer Health is cutting-edge with its innovative approach to Home...
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Project Engineer II
18 hours ago
Escondido, United States Baker Electric Full timeJob Description Posted Wednesday, January 3, 2024 at 8:00 AM At Baker Electric we are energized by truly living our values - Team Builders, Relentless Follow Thru, All-In, and Care for Others. When our team members work together with these things in mind, we do great things both individually and as an organization. Being an employee-owned company shows our...
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Senior Clinical Data Manager
2 weeks ago
Escondido, United States Allen Spolden Full timeJob DescriptionThe Clinical Data Manager manages the general conduct of project assigned tasks as the Lead Data Manager or under advisement from senior members of the Data Management Team. Responsible for oversight and conducting data activities in an efficient manner and in accordance with regulations. Responsibilities include all data management...
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Behavioral Health Clincian
4 days ago
Escondido, United States Palomar Health Full timeRequisition ID 37842 Department Behavioral Health Emergency Services Location Escondido, California Union Not Applicable Salary Range 39.87 - 59.89 Job Type Per Diem Shift Varies Hours Per Shift 12 Hours Per Pay Period 0 Position at Palomar Health Description Responsible for providing behavioral health and risk assessment as well...
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Escondido, United States Neighborhood Healthcare Full timeCommunity health is about more than just vaccines and checkups. It's about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We're with you every step of the way, with the care you need for each of life's chapters. At Neighborhood, we are Better Together.As a...
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Escondido, United States Neighborhood Healthcare Full timeCommunity health is about more than just vaccines and checkups. It's about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We're with you every step of the way, with the care you need for each of life's chapters. At Neighborhood, we are Better Together.As a...
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Project Manager
16 hours ago
Escondido, United States Bilbro Construction Company Inc. Full time $90,000 - $125,000Benefits:401(k)Dental insuranceHealth insuranceLife insurancePaid time offJob Classification: Project Manager – Construction Location: Escondido, CA Travel Involved: 25% Job Type: Full Time Education:...
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Lead Cook
2 weeks ago
Escondido, California, United States Hyatt Vacation Club at The Welk Full timePay: $25.20Job SummaryPrepare special meals or substitute items. Regulate temperature of ovens, broilers, grills, and roasters. Pull food from freezer storage to thaw in the refrigerator. Ensure proper portion, arrangement, and food garnish. Maintain food logs. Monitor the quality and quantity of food that is prepared. Communicate assistance needed during...
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Senior Participant Services Associate I
3 weeks ago
Escondido, United States Navia Benefit Solutions, Inc. Full timeThe Pay Range is $21.00-$22.50/Hr. About the CompanyNavia is a national, consumer-directed benefits provider serving 10,000+ employers across all 50 states. The company provides comprehensive health, finance, lifestyle, and compliance solutions to employers and consumers. We take pride in offering industry-leading customer service, communications, and...
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Lead Cook
1 week ago
Escondido, United States Hyatt Vacation Club at The Welk Full timePay: $25.20 Job Summary Prepare special meals or substitute items. Regulate temperature of ovens, broilers, grills, and roasters. Pull food from freezer storage to thaw in the refrigerator. Ensure proper portion, arrangement, and food garnish. Maintain food logs. Monitor the quality and quantity of food that is prepared. Communicate assistance needed during...
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Escondido, United States Neighborhood Healthcare Full timeCommunity health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better...
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Lead Cook
2 weeks ago
Escondido, United States Hyatt Vacation Ownership Full timeAre you ready to grow your dream career while making others' vacation dreams come true? Marriott Vacations Worldwide is a world premier organization for Vacation Ownership with resorts at destinations around the globe. Join our team and help deliver unforgettable experiences that make vacation dreams come true. Pay: $25.20 JOB SUMMARY Prepare special...
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Senior Participant Services Associate I
2 weeks ago
Escondido, United States Navia Benefit Solutions, Inc. Full timeThe Pay Range is $21.00-$22.50/Hr. About the Company Navia is a national, consumer-directed benefits provider serving 10,000+ employers across all 50 states. The company provides comprehensive health, finance, lifestyle, and compliance solutions to employers and consumers. We take pride in offering industry-leading customer service, communications, and...
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Registered Nurse
2 weeks ago
Escondido, United States Rady Children's Hospital Full timeJOB SUMMARY: The Clinical Nurse II collaborates with physicians and multidisciplinary team members. Responsible for independently applying the nursing process through the assessment, planning, implementation, evaluation and documentation of pediatric patient care. Resolves patient problems and needs by applying multidisciplinary team strategies. Selects and...
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Housing Locator
3 hours ago
Escondido, United States Equus Full timeJob Description Have knowledge of the homeless community and County demographics. Implement and apply regulations to daily duties. Exercise attention to detail. Organize, prioritize, and complete a large volume of work within strict time deadlines. Build and maintain positive relationships with landlords and property management companies serving low-income...
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Assistant Sales Manager
2 weeks ago
Escondido, California, United States Member Relations Full timeJob SummaryAssists the Sales Manager with the operation of the sales gallery, which includes scheduling Sales Executives in order to meet customer flow, reviewing weekly reports and disseminating this information to the sales team, and being available to assist sales executives with closing sales. Helps generate new business and attracts potential owners by...