Job Title: Case Manager
Profession: Registered Nurse
Specialty: Utilization Management
Duration: 13 weeks
Shift: Day
Hours per Shift: 8 hours
Experience: Minimum 2 years
License: CA License required
Certifications: BLS required
Must-Have:
- Previous Charge Experience: Required
- Patient Ratio Experience: 20 or more
- Community Client Experience: Preferred
- LTAC Experience: Preferred
- Trauma Level I Experience: Preferred
- Trauma Level II Experience: Preferred
- Travel Experience: Required
Description:
The role coordinates utilization management, resource management, and discharge planning.
It oversees the management of acute patient populations across the care continuum.
The focus is to provide coordinated and integrated care to prevent unnecessary admissions or readmissions.
Responsibilities include discharge planning coordination and intervention for high-risk patients.
The role promotes patient wellness and improved care outcomes.
Efficient utilization of health services and minimizing denials of payment among patients with complex health needs are key objectives.
Skills in care coordination, discharge planning, and utilization of guidelines are necessary.
Experience with appeals, denials, concurrent reviews, and medical necessity is essential.
Knowledge of coding, compliance with health regulations, and commitment to quality assurance is required.
Familiarity with patient demographics such as adults and geriatrics is beneficial.
The daily census is typically 100-120 with around 50 visits per day.
Collaboration with interdisciplinary teams is expected to ensure comprehensive patient care.