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  • Irvine, CA

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Case Manager

Maxim Healthcare Services • Irvine, CA

Posted 1 month ago

Job Snapshot

Other Great Industries
Health Care, Professional Services

Job Description


Assess, plan,implement, coordinate, monitor, and evaluate case management activities acrossthe continuum of care, within the scope of the case manager's license,including: Coordination and service delivery, Physical and psychologicalfactors, Benefit systems and cost benefit, Case management concepts andCommunity resources. Understand and maintain confidentiality of legal andethical issues at all times. Check eligibility as per procedure/ clientspecifications; if there is an eligibility problem, the case manager notifiesthe caller and consults the case management supervisor. Assess initial clinicalinformation and develop a treatment plan and goals that meet the individualpatient's/ clients present needs. Communicate goals and objectives to allpertinent parties. Evaluate and certify all cases for potential complications,and cases that would benefit from alternative care. Assess clinical informationat established intervals to evaluate the effectiveness of the case managementplan for each patient. Evaluate and communicate the case objectives and goalsto the individual patient's case management team. Consult physician advisers todetermine the medical necessity and appropriateness of treatment plan goals andobjectives. Evaluate all referral sources and their qualifications to assurequality outcomes. Determine the cost effectiveness and medical necessity ofalternate treatment. Negotiate with providers when necessary to reduce patientcost. Work closely with the family members of patients to involve them inpatient care. Assess the psychological characteristics of wellness and illness.Note possible experimental/ investigational procedures and notify payer percontract specifications. Maintain an open line of communication with allparties of the individual case management treatment team to include patient,family, payer, and service providers across the continuum of care. Remain awareof and follow all departmental policies and procedures. Answer calls as neededfor individual assigned units. Assume other duties as assigned and directed bythe case management supervisor.

Specific Duties:

1. Clinical review for inpatient status and medical necessity 
2 communicating with hospitalist on daily rounds. Who is dischargingObservation vs inpatient status 
3. Communicating with the hospital case managers 
4. Transferring patients to higher level of care 
5. Filling in for staff on PTO 
6. Chart review, pulling Data and entering Data only 

Must have qualifications/experience: 
1. Either a LVN/RN license 
2. Approx. 2 years hospital experience 
3. 1-2 years case management experience 
4. Be familiar with Milliman or Interquel programs 
5. Strong computer skills

Shift Start/End Time: 8amto 5pm 1 hour lunch break 

Dress Code: Office dress 


•        Active R.N. nurse licensurein the state of operation

•        Minimum of 3 years clinicalpractice experience in state of operation

•        A Bachelors (orhigher) degree in a health-related field preferred.

•        Case managementcertification preferred. Previous case management experience preferred.

•        Ability to apply thesix (6) essential activities of case management within the five (5) corecomponents

At Maxim Healthcare Services, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
  • Competitive pay & weekly paychecks
  • Health, dental, vision, and life insurance
  • 401(k) savings plan
  • Awards and recognition programs 
*Benefit eligibility is dependent on employment status. 

Maxim Healthcare Services is a leading provider of home healthcare, medical-related staffing, travel nursing, and population health and wellness services across the United States. As an established community partner, we have been making a difference in the lives of our employees, caregivers, and patients for more than 30 years. Our commitment to customer service, improving patient care, and staffing experienced healthcare professionals has paved the way for many rewarding career opportunities in the healthcare industry.  

Maxim Healthcare Services, Inc. is an Affirmative Action/Equal Opportunity Employer
Job ID: 462110
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