RN CASE MANAGER Job in Los Angeles, California US
Job Details:
- AMERICAN HEART ASSOCIATION - BLS
- CA LICENSE - RN
- FIRE/SAFETY CARD (must be presented within 30 days from DOH)
- 1-3 years of experience
POSITION SUMMARY:
The RN Case Manager coordinates, negotiates and manages the length of stay of an assigned group of patients in order to insure that the course of treatment is cost-effective, and the care is consistent with the requirements of managed care companies and CMS so that the hospital will be reimbursed for its services.
ESSENTIAL DUTIES AND RESPONSIBILITIES (not all inclusive)
1. Reviews all admissions within 24 hours of admission against Interqual criteria
2. Discharges or converts as appropriate the Outpatient admissions patients per clinical criteria, hospital policies and guidlines.
3. Obtains initial authorization for services within 24 hours of admission with clinical review reported to Managed Care Organization before end of working day.
4. Performs daily concurrent reviews using InterQual criteria and clinical judgment and guidelines.
5. Applies nursing department high-risk screening criteria accurately, identifying patients requiring comprehensive case management services within 24 hours of admission.
REQUIREMENTS
Current and Valid License in the State of California as a Registered Nurse. BSN preferred,
CCM preferred. One year case management or utilization review experience preferred. Los Angeles City Fire/Safety Card within 30 days of hire. Current BLS Card issued by American Heart Association. A minimum of 3 years nursing experience preferred. Possess the ability to work independently. Must be able to use verbal, non-verbal and written communication skills which reflect nursing standards. Demonstrates knowledge of proper documentation.
M/F/D/V
EEO