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Case Managers function as liaisons between patients, their families, payors, and healthcare personnel to ensure appropriate movement along the continuum of care.
Job Responsibility
Coordinate discharge needs, quality of care, and implementing the utilization management process for acute inpatients
Perform concurrent review and denials management based on acute care guidelines with a focus on authorization and reimbursement, appropriateness of admission, length of stay, and avoidable delays in discharge
Collaborate with the family, the care team, third party payors, and outside providers to coordinate discharge needs including home health, durable medical equipment, and safe transitions of care
Requirements
BLS for Health Providers (American Heart Association)
California RN License
Bachelor's Degree in Nursing
4 years nursing in an acute hospital or 2 years Case Management, Utilization Review, or Discharge Planning experience in an acute hospital
Nice to have
Experience in a pediatric acute hospital
Familiarity with Interqual or Milliman Care Guidelines
Experience navigating the electronic medical record (Epic)
What we offer
Health Plan (Medical, Dental, Vision)
403(b) Retirement Plan with match that increases with years of service
Tuition Reimbursement up to $10,000 per year, paid time off for seminars