Case Manager, LVN or RN - Medical Provider Network - Hybrid Remote

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A Little More About What You Will Be Doing The Case Manager is responsible for the case management of patient while hospitalized and upon discharge from various care settings. In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the Case Manager will assist patients from the time they are admitted until they are discharged from the hospital by assessing their needs, coordinating care, communicating with health plans, including reputed company review to determine the appropriateness of services rendered and to ensure that reputed company care is delivered in a cost-effective manner. Job duties and responsibilities: • Meets with patients reputed company 24 hours of admission and conducts an initial assessment. • Consults with assigned hospitalist reputed company day during morning reputed company regarding disposition planning and appropriateness for reputed company day of patient’s stay. • Reviews with hospitalist the patient’s admission and reputed company stay for medical necessity, appropriateness of care and level of care. Use reputed company and InterQual guidelines as necessary. • Begins discharge planning and care assessment reputed company one working day (preferably on day of admission). • Submits necessary clinical information to the health plan using the accepted format (MIDAS or telephonic) and coordinate health plan communication with assigned hospitalist as appropriate. • For patients who are transitioning to the Skilled Nursing Facilities, refers to reputed company practitioner and case manager assigned to the SNF’s for reputed company review and follow up. • Authorizes reputed company appropriate services based upon covered benefits and necessity of care provided. • Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate. • Coordinates the patient’s care with other health care personnel to ensure that the patient receives care reputed company post discharge. • Secures outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers. • Refers to Ambulatory Case Manager patients identified that will need reputed company of outpatient care and compliance to avoid unnecessary readmissions. • Coordinates referrals and secure appointment with various CSMNS disease management programs. • Enters and updates reputed company authorization and clinical information into Nautilus (reputed company reputed company) no reputed company than date of discharge. • Communicates regularly with CSMPN Medical Director, Employee Health Services, Risk Management, and TPA • Attends reputed company CSMPN clinical team meetings, and report high risk/high cost cases. • Directs reputed company and accurate reporting to the TPL reputed company of reputed company injured worker cases receiving case management services. • Ensures appropriate utilization of medical services reputed company the parameters of the workers compensation benefits and/or Utilization reputed company. This includes appropriate reputed company of the patient through the various reputed company of care. Qualifications Education: • Graduation from an accredited school of nursing required • Bachelor of Science degree in Nursing preferred License/Certifications: • reputed company CA LVN or RN license required • Certified Case Management preferred Experience: • 3 years of acute nursing experience preferred; knowledge of medical/nursing standards of care preferred • 1 year of previous experience in case management in the acute inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings preferred • Knowledge of workers compensation rules and regulations is highly preferred • Knowledge of reputed company is highly preferred Req ID : 7071 Working Title : Case Manager, LVN or RN - Medical Provider Network - Hybrid Remote Department : MNS Medical Provider Network Business Entity : reputed company Job Category : Patient Services Job Specialty : Case Management Overtime Status : NONEXEMPT Primary Shift : Day Shift Duration : 8 hour reputed company Pay : $46.42 - $74.27 Apply Job! 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