RN/LVN Inpatient Case Manager-MH357
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POST DATE 8/8/2016
END DATE 11/9/2016
JOB DESCRIPTIONImmediate need for an Inpatient Case Manager (RN or LVN).
Inpatient Case Manager will manage all inpatient hospitalizations, skilled nursing stays and levels, for in-network and out-of-network services, hospitalizations, and chronic/high risk care management for all full risk members.
Key responsibilities for this role are:
? Telephonically interface with Patients and families during the discharge planning process and oversee the activities of the Hospital D/C planners, assessing the patient's needs, identifying resources and coordinating a smooth transition from one level of care to another.
? Successfully utilize appropriate contracted facilities and providers, ensuring cost containment and appropriate utilization of services.
? Act as the liaison with the Patient and family, the Hospitalist, Primary Care Physician and Health Plan to ensure appropriate and timely coordination of care.
? Effectively advise and manage admission statuses of Inpatient and Observation.
? Actively participate in referrals to appropriate Disease Management Programs and identify/'report patients with high risk needs that would benefit from the case management programs.
? Conduct routine reviews of ER utilization and retrospective review of all 1 and 2 day LOS admissions, and report findings at monthly UM meeting.
? Function as clinical resource to Utilization/Quality/Outreach Management Coordinators.
? Refer high-risk cases to the Outreach Program for continued case management and coordination of care.
? Foster positive interaction and relationships with all internal departments and staff.
? California Registered Nursing License, or LVN with additional relevant clinical experience.
? Minimum 2 years case management, utilization / discharge planning experience in an IPA, Group, Hospital/Health Plan environment, or other qualifying clinical experience
? Milliman or Interqual guidelines preferred
? EZ-Cap information system preferred
Qualified candidates please submit your resume for immediate review to this ad and contact Monique Herrera in regard to your interest.
Pay is DOE and license qualification. We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.
Current CA RN or VN License. Min 2yrs CM, UM, D/C, exp in an IPA, Group, Hospital/Health Plan setting. preferred knowledge: Milliman or Interqual guidelines and EZ Cap system knowledge.