RN - Case Management

The Case Manager is responsible for utilization review and case management activities within the hospital. This position involves performing chart reviews, quality assessments, and ensuring appropriate patient discharges while adhering to the established criteria.

• Perform chart reviews and quality assessments on all patients using Severity of Illness (SI) and Intensity of Service (IS) Inter Qual criteria.
• Identify and implement case management interventions for cases with less predictable outcomes.
• Monitor observation cases to ensure timely discharge or admission for inpatient services.
• Initiate Medi-Cal TARs at admission and document daily using SI and IS criteria.
• Evaluate the case management plan in response to changing patient care situations.
• Educate physicians and hospital staff on criteria for utilization management.
• Prepare documentation for denial letters and assist in the appeals process.
• Address complex patient situations with innovative problem-solving skills.
• Identify inappropriate bed utilization and quality of care issues for referral to the physician advisor.

• Two years of clinical experience.
• Two years of case management experience or certification in case management.
• Current BCLS certification.

• Health Benefits:
  
  Medical, Dental, Vision, Life, and more
• Onboarding Made Easy:
  We handle physicals, titers, and more so you can focus on care
• Clinical Support:
  In-house clinical team available to assist and advocate
• 401k Retirement Plan:
  Eligible after waiting period; 4% match with 5% contribution
• Recruiter Matching:
  Get paired with a recruiter based on your location and specialty
• Extras:
  Travel reimbursement, housing allowance, meals, referral bonuses, and more

Location:

CA 90505