This position supports the Mission of the Hospital through the provision of distinctive and compassionate care to our patients. This position is responsible for utilization review, assessment of discharge planning needs and coordination of effective discharge plan.
QUALIFICATIONS
Current CA Nursing License RN
Current CPR BLS for healthcare provider’s card upon hire
Two years previous clinical experience in acute care setting. Minimum one year experience as case manager in acute care setting.
Demonstrate the knowledge and skills necessary in Case Management with an understanding of severity of illness and intensity service.
Ability to demonstrate knowledge and skills necessary to provide care appropriate to the age served on the unit. Possess knowledge of growth and development over the life span.
Must be able to type and use an EMR.
Must know the InterQual process.
Key Responsibilities:
Reviews emergency department and inpatient admissions for medical necessity using InterQual criteria, obtains authorizations from health plans, communicates with physicians regarding admission status and denials, and maintains accurate documentation in electronic medical records.
Responsible for conducting utilization review and case management activities to ensure appropriate level of care, regulatory compliance, and effective discharge planning.
Obtain and manage payer authorizations and communicate coverage determinations.
Coordinate comprehensive discharge planning and post-acute care services.
Identify patients at risk for readmission and facilitate community resource referrals.
Collaborate with physicians, nursing, social work, and external providers to assess needs and coordinate discharge planning
Monitor quality-of-care issues and report concerns to Quality Management.
Educate healthcare staff on case management processes and best practices.
Support compliance activities, audits, and payer relations
Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for College Medical Center roles, including but not limited to shift differential and other special pay practices, etc. The posted compensation for the position is a reasonable estimate that extends from the lowest to the highest pay that College Medical Center in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.
EEO Statement
All College Medical Center subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. College Medical Center subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
Notice
We are aware of a scam whereby imposters are posing as Recruiters from College Medical Center, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.
At College Medical Center and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at College Medical Center and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. Email correspondence will come from the domains @collegemedicalcenter.com or @glendorahospital.com.
If you suspect a fraudulent job posting or job-related email mentioning College Medical Center or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate College Medical Center subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.
