RN - Case Manager
RN - Case Manager
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Location: San Pedro CA
Schedule: 08:00 16:30 (5x8; Self-scheduling; every other weekend)
Duration: 13 weeks
Pay Rate: $68/hr (W2) $72/hr (1099)
- Perform Care Coordination Utilization Review and Discharge Planning for acute care patients (Medical-Surgical Telemetry ICU and occasional ER).
- Conduct admission criteria reviews using InterQual guidelines.
- Facilitate concurrent and continued stay reviews to determine medical necessity per evidence-based guidelines.
- Coordinate services with interdisciplinary teams including physicians social services and interpretation services.
- Arrange necessary resources and equipment (DME) complete prior authorizations and initiate post-acute referrals.
- Document all case management activities in Epic EMR system.
- Ensure compliance with CMS HIPAA The Joint Commission and California Department of Health regulations.
- Participate in weekend rotation; patient load may exceed 15 patients on weekends based on census.
- California RN license (active and unencumbered).
- Minimum 2 years acute medical Case Manager experience in California performing all of the following:
- Care Coordination
- Utilization Review
- Discharge Planning
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- Proficiency with InterQual and Epic.
- Experience with Medical-Surgical Telemetry ICU and some ER case management.
- Seasoned traveler experience (first-time travelers may be screened by manager).
- DRG coding knowledge
- Prior authorization and retrospective review experience
- Workers compensation case management
- Knowledge of NCQA and HEDIS measures
- Setting: Acute hospital Case Management/Utilization Review
- Patient Age Groups: Adults Geriatrics
- Daily Census: 50 55
- Typical Caseload: 1:15 weekdays; may be higher on weekends
- Support Services: Social Services Interpretation Services
Employment Type
Full-time
