Registered Nurse (RN) - Case Management - $40-53 per hour

ScionHealth - Kindred Cornerstone & Solara Hospitals is seeking a Registered Nurse (RN) Case Management for a nursing job in Rancho Cucamonga, California.

Job Description & Requirements

• Specialty : Case Management
• Discipline : RN
• Duration : Ongoing
• 36 hours per week
• Employment Type : Staff

Description

$22.59 - $33.89

We would expect those hired into this job would be paid within this pay range, however, certain circumstances may allow us to pay outside of this range.

ScionHealth is committed to a culture of service excellence as demonstrated by our employees’ adherence to the service excellence principles of Pride, Teamwork, Compassion, Integrity, Respect, Fun, Professionalism, and Responsibility.

As our most acute level of care, our specialty hospitals offer the same critical care patients receive in a traditional hospital or intensive care unit , but for an extended recovery period.

Our clinicians play a vital role in the recovery process for chronic, critically ill and medically complex patients.

Job Summary

Under the supervision of the Director of Case Management (DCM) or designee, completes various duties to enhance the efficiency of the Case Management Department, as well as support the daily functions of the Case Managers.

This role assists in securing arrangements for the discharge transition and post-acute services. Works with the Case Management team to monitor and obtain insurance verifications and concurrent authorizations.

Assists with denial prevention and management as requested, aiding with the peer-to-peer coordination, and denials / appeals tracking.

This position serves as a liaison between the Case Management department, payers, post-acute providers and various other entities.

Essential Functions

• Provides assistance to the Case Management staff, including, but not limited to; creating and sending referral packets, organizing admission and discharge patient records, making phone calls, obtaining signatures, or any other assistance needed as determined by the DCM.
• Assists the Case Management team in scheduling family conferences.
• Assists the Case Management team by making necessary arrangement for post-discharge follow-up care.
• Functions as the point of contract and liaison for the hospital Case Management department staff regarding clinical insurance review completion and / or issues.
• Forwards the necessary patient clinical information for all admission, concurrent, and retrospective insurance reviews to payers for the completion of medical necessity reviews.
• Monitors, follows-up, documents and tracks payer responses / requests of completed clinical reviews, including; approvals, appeals and denials and communicates these to the appropriate people (hospital staff, physicians, DCM, Case Manager(s), Clinical Denial Management, and Centralized Business Office CBO ).
• Monitors and tracks the total hospital certified days of the patient for payers (commercial, managed care, and Medicaid) and communicates missing certifications to the DCM, Case Manager(s), and CBO.
• Initiates and completes insurance pre-certification for patients lacking certification. Communicates pre-authorization outcomes to appropriate individuals (hospital and CBO).
• Organizes and prepares the necessary clerical elements for the weekly Interdisciplinary Team Meeting and other Case Management meetings.

Knowledge / Skills / Abilities / Expectations

• Must read, write and speak fluent English.
• Must have good and regular attendance.
• Ability to learn logistics of insurance verification and certification process, case management and discharge planning tasks.
• Clinical knowledge to read, interpret, and communicate information in the medical record that identifies diagnoses, treatment plans, interventions and medical necessity for hospitalization.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation / collaboration from hospital leadership, as well as physicians, payers and other external customers.
• Ability to work under stress, multitask, and to respond quickly in urgent situations.
• Performs other related duties as assigned.
• Approximate percent of time required to travel : 0%

Qualifications

Education

College degree in a healthcare related field preferred

Licenses / Certification

None required.

Experience

1 year in a healthcare setting.

ScionHealth - Kindred Cornerstone & Solara Hospitals Job ID #510955. Posted job title : Case Management Coordinator

About ScionHealth - Kindred Cornerstone & Solara Hospitals

Defined by its team of approximately 22,000 talented, heroic caregivers, ScionHealth strives to provide quality-driven, patient-centered acute and post-acute hospital solutions in communities across the country.

The health system is focused on driving innovation and investing in people and technology to deliver compassionate patient care and excellent health outcomes in ways that lift a community and improve health equity.

Based in Louisville, Kentucky, ScionHealth operates 79 hospital campuses in 25 states - 61 long-term acute care hospitals, and 18 community hospital campuses and associated health systems.

ScionHealth launched in December 2021 following a transaction between leading healthcare companies LifePoint Health and Kindred Healthcare, with talent and resources from both companies combining to form an organization devoted to providing great care to tens of thousands of patients annually.

For years, the hospitals now operated by ScionHealth have been vital to the communities they serve as medical providers, as supportive employers, and as inclusive partners in giving back.

ScionHealth is proud to inherit this role and find innovative ways to grow and evolve for years to come.