Description: The scope of duties encompasses a variety of tasks related to performing the following: integrated concurrent review for utilization; quality and risk; discharge planning; and case referrals for patients. This position works with medical and professional staffs to obtain appropriate clinical documentation for review and to meet inpatient criteria by the Interqual Guidelines. The Case Managers are responsible for the research and appeal UR denials; micro management of patients to ensure appropriate and timely resource utilization; timely and accurate communication to insurance utilization review for certification of admission and continued stay. This position also coordinates patients care with an interdisciplinary team; screens and coordinates authorization of requests for capitated services for all assigned managed care where the hospital has a financial responsibility; participates in peer review; an is pro-active in reducing avoidable days. Hours vary depending upon assignment. Rotate Saturday/Sunday coverage. This is a non-exempt position.
- Current license as a Registered Nurse in California, or related health care professional.
- Three years Case Management/UM experience in an acute care facility;
- Knowledge and experience with Medi-Cal preferred
- Good communication skills and ability to work with others;
- Basic computer skills
Job : Case Management/Home Health
Primary Location : CA-Indio
Hospital/Facility : 266-John F. Kennedy Memorial Hospital - Indio, CA
Job Type : Full-time
Shift Type : Days