Overview
The RN Case Manager uses InterQual criteria to evaluate the appropriateness of admissions, concurrent stay and readiness for discharge.
She / he assures correct level of care : critical, telemetry, acute, observation, for all patients. The Case Manager provides an efficient, coordinated approach to clinical management, with an emphasis on discharge planning, care coordination and utilization management activities for select patient populations across the continuum of programs and services at AHMC.
The essential functions of the RN Case Manager require constant collaboration with the Social Workers, Nursing staff, Financial Counselors, Medical Staff to coordinate the care of patients in a proactive manner.
Responsibilities
The position requires the full understanding and active participation in fulfilling the mission of AHMC- Anaheim Regional Medical Center.
It is expected that the employee demonstrate behavior consistent with the core values. The employee shall support AHMC- Anaheim Regional Medical Center strategic plan and goals and direction of the performance improvement plan.
Qualifications
- 2 years Utilization Management / Case Management experience preferred in acute care setting.
- Working knowledge of Interqual, Intensity of Service / Severity of Illness criteria.
- Working knowledge of Title XVII and Title XIX.
- Working knowledge of reimbursement related to Medicare, Medi-Cal, Capitation, and Managed Care is required.
- Ability to negotiate orders with the physicians in order to assign alternate levels of care.
- Working knowledge of community resources.
- Working knowledge of methods to resolve patient needs such as discharge planning, Home Health, DME and SNF’s.
- Ability to case manage smoothly and increase patient / physician satisfaction while staying within guidelines.
- Ability to track outcomes and report findings.
- Able to problem solve effectively.
- Ability to use clinical knowledge to identify potential quality issues, delays in service, post-acute care needs required.
- Must have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, and positive personal influence and negotiation skills.
- Must have strong clinical assessment and critical thinking skills necessary to provide utilization review / discharge planning services appropriate to patients with complex medical, emotional and social needs.
- Must have the ability to work in a high volume caseload environment and deal effectively with rapidly changing priorities.
- Excellent computer skills with word, excel and power point.
Registered Nurse (RN) - Case Manager
However, RN Case Manager preferred. At least one year experience in case management, discharge planning or nursing management, preferred. ...
Case Manager Utilization Rn- Per Diem
TITLE: Case Manager Utilization RN- Per Diem. Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA and DOL. Two (2) years combined RN experience in an acute care setting or case management r...
RN Case Manager
We have Travel jobs available for RN’s with 2+ years of Acute Care Case Manager experience in Paramount, California. Our travel recruiters can help you earn more money while attaining your ideal work-life balance. ...
Case Manager Rn - Obgyn
Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement. In conjunction with the Physician, implements care/treatment plan by coordinating access...
Inpatient RN Case Manager
As a Registered Nurse, Care Manager, you will provide professional nursing care by assessing, planning, implementing, and evaluating the care of patients under the supervision of a clinician or RN, Supervisor, or RN Charge Nurse. From California to Oregon and Washington, we are focused on helping mo...
Case Manager - RN or LVN, Per diem, days
The RN Case Manager manages a continuum of care from pre-admission through post-discharge for assigned patients. Maintain an active California RN license. Previous experience in case management preferred. ...
Complex Case Manager RN - Oncology (Remote)
In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of interna...
High Intensity Case Manager, RN
Case Manager’s ability to effectively manage a panel/caseload of high-risk members in collaboration with Nurse Practitioner, Pharmacist, PCP, SPC, health plans and other ICT members. The scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropr...
Senior Complex Case Manager- Adult (RN)
We have an opportunity to join the Alliance as a Senior Complex Case Manager - Adult (RN) on the Care Management team. Working with and educates members, families, providers, external agencies and internal departments on the Case Management Program and providing assistance as needed. Current unrestr...
Bilingual Spanish RN Case Manager, SNP (Must Have California RN License)
Overview of the Role: Alignment Health is seeking a remote bilingual Spanish RN case manager (must have California RN License) to join the case management, special needs program (SNP) team. Health plan experience preferred * Must have and maintain an active, valid and unrestricted RN ...