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Inpatient Case Manager

UCLA Health Type Full time Posted 7/1/2014
Salary - n/a - Starts 7/31/2014
CA - California (All) - Los Angeles Referral - n/a -    
 

Job Duties

Under the direction of the Utilization Management Manager and Associate Medical Director, the Inpatient Case Manager works with designated physician advisors; the attending physician and health plan representatives, to develop optimal care plans with appropriate resource management. This position is responsible for providing clinical care coordination, utilization management, and discharge planning for UCLA Medical Group assigned members who are hospitalized; including documentation of work in designated IT systems. This position is also responsible for implementation of protocols and programs to assist and educate the network physicians in providing optimal care within the parameters of the regulatory guidelines.

Job Qualifications

Minimum of recent 3 years combined case management or clinical experience providing direct patient care and utilization review/case management experience in an HMO environment (i.e. MSO, IPA, or health plan setting)

Working knowledge in the use of InterQual, Medicare or other medical management guidelines.

Knowledge of legislative requirements, NCQA guidelines and health plan delegation requirements for utilization management.

Familiarity with CPT-4, ICD-9, RBRVS, and HCPCS codes as well as thorough understanding of Medicare Guidelines, COB and TPL coordination.

Thorough knowledge of health care industry, benefit interpretation, professional/facility reimbursement methodologies, contracts and flow of related information.

Must have strong problem solving skills. Ability to analyze problems and formulate plans, solutions and a course of action.

Ability to multi-task, meet deadlines and maintain department production and quality standards.

Proficient computer skills including Microsoft Excel and Word. Competence in navigating the internet.

Substantial working knowledge of utilization review/referral processing systems (i.e. EZ Cap, Diamond, IDX).

Excellent interpersonal, verbal and written communication skills. Ability to articulate clinical and non-clinical information to individuals of all levels of understanding.

Ability to work Business hours 8:00am - 5:00pm.

RN License or LVN License is required. BSN highly preferred.