About the Role
We are currently seeking a highly motivated Case Manager. This role will report to a Manager - Case Management and enable us to continue to scale in the healthcare industry, focusing on SNF, SA, ARU, LTAC level of care.
What You'll Do :
- Comply with Case Management Department’s policies and procedures.
- 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management
- Utilize Milliman Care Guidelines, CMS, Title 22 guidelines and criteria for appropriateness of transition of care for members in SNF, SA,ARU, LTAC setting.
- Collaborating with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission
- Responsible for coordinating the required initial and concurrent reviews based on the review of medical records received and accurate reporting of all admissions to Medical Director and Manager and / or Supervisor of Case Management Department
- Review of medical records and / or other documentation to determine medical necessity, appropriateness and level of care utilizing Milliman Care and other appropriate Guidelines
- Assess, plan, implement, coordinate, monitor, and evaluate all options and services with the goal of reducing hospital readmission
- Attends / coordinates Case Management meetings on and off-site as necessary
- Interacts with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements
- Attend to provider and interdepartmental calls in accordance with exceptional customer service
- Maintain good relationships with health plans, facilities and medical directors. Resolve problems that arise with any IPA medical directors.
- Report to Manager and / or Supervisor of Case Management on activities and / or problems occurring throughout the day
Qualifications :
- Active Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license in California
- Ability to commute to our Monterey Park, CA office
- Experience using Microsoft applications such as Word, Excel and Outlook
- Two (2) years of clinical experience as an LVN
- Skilled Nursing Facility experience a plus
You're great for this role if :
- Excellent analytical critical reasoning
- Proven ability to prioritize multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlines
- Ability to educate and train staff members and other departments as needed
- Experience using EZCAP
- Strong communication and customer service skills
- Punctual, Creative, self-motivated.
- Professional appearance and conduct.
- Conceptual and big picture understanding.
- Able to function independently under time constraints.
- Willing to learn and develop new responsibilities and skills.
- Good organization, critical thinking and problem solving skills.
- Must be detail-oriented and able to work autonomously but also as a team member.
- Have experience in SNF case management
7 days ago