RN Case Manager - Patient Care Coordination​/Req

RN Case Manager - Patient Care Coordination

Under the direction of the Director of Case Management, the RN Case Manager prioritizes, plans, and monitors the patient’s progress through the Antelope Valley Medical Center system. The Case Manager assesses appropriate medical care, promotes continuity of care, and provides guidance to the LVN Discharge Coordinator, Discharge Coordinator Assistant, and Utilization Review Assistant.

• Case Management: identify care not meeting acute care criteria, recommend alternative cost-effective services, maintain knowledge of payer regulations, act as resource for physicians and nursing staff, facilitate transitions, assist onsite reviewers, use HDM and LING systems, serve as advocate, report abuse, perform other duties as assigned.
• Utilization Review (UR) Management: complete admission, concurrent, and retrospective reviews, evaluate documentation, notify physicians of issues, utilize PCC Physician Advisor, monitor payer authorizations, complete required documentation, develop action plans for metrics, identify trends, intervene with physicians and payers, review denied claims, support appeals, provide physician education, refer to discharge coordinator or social worker.
• Discharge Planning: develop, implement, and document individualized discharge plans, update throughout hospital stay, communicate plan, facilitate appropriate level of care, obtain authorizations, negotiate with payers, coordinate placements, transfers, medical transportation, assess home health/infusion/DME needs, provide referrals, maintain knowledge of resources.

• Knowledge:
  Inter Qual Guidelines, government and payer utilization and billing guidelines, Microsoft Office, medical terminology.
• Skills:
  
  basic PC usage, operation of scanners, copiers, fax machines, oral and written communication, interpersonal and customer focus.
• Abilities: handle stress, manage heavy caseload efficiently, maintain relationships with facilities, document account info, run case management reports.

• High School graduate or equivalent;
  Bachelor’s degree in nursing preferred.
• Minimum 3 years of broad-based acute care nursing experience; case management, discharge planning, and/or home health experience preferred.

• Registered Nurse License.
• CPR Certification.

• Adhere to attendance, punctuality, leave of absence, PTO, dress code, telephone etiquette, and hospital policies.
• Organize work, set priorities, expand initiative, function under pressure, communicate effectively, maintain confidentiality, follow safety rules, use equipment properly.
• Understand and comply with compliance and integrity program, code of conduct, quality improvement guidelines, and accreditation requirements.

• Climate-controlled area; standing/walking 75% of time; tolerate repetitive arm and hand movements.

Seniority level:
Not Applicable.

Employment type:

Full-time. Job function:
Health Care Provider.