Registered Nurse Case Manager
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Job Location:
Santa Barbara County, CA - USA
Monthly Salary:
Not Disclosed
Posted on:
5 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Summary:
The Registered Nurse Case Manager is responsible for utilization management quality assurance and discharge planning activities. The role aims to achieve quality outcomes optimal care/cost management and high customer satisfaction. This position requires active functioning as an RNCM with hands-on experience in inpatient care coordination discharge planning and post-acute clinical payer authorization.
The Registered Nurse Case Manager is responsible for utilization management quality assurance and discharge planning activities. The role aims to achieve quality outcomes optimal care/cost management and high customer satisfaction. This position requires active functioning as an RNCM with hands-on experience in inpatient care coordination discharge planning and post-acute clinical payer authorization.
Location:Santa Barbara California United States
Responsibilities:
- Perform utilization management quality assurance and discharge planning.
- Coordinate care to ensure quality outcomes and cost-effective services.
- Conduct inpatient care coordination.
- Manage discharge planning processes.
- Handle post-acute clinical payer authorizations.
- Utilize InterQual and Milliman guidelines for reviews.
- Conduct concurrent and retrospective reviews.
- Manage appeals and denials.
- Ensure compliance with regulatory standards (CMS Department of Health The Joint Commission etc.).
- Perform CPT and ICD-10 coding and billing.
- Participate in data entry and documentation in EPIC.
- Answer phone calls and direct them accordingly.
- Coordinate equipment and supply needs.
- Perform utilization management quality assurance and discharge planning.
- Coordinate care to ensure quality outcomes and cost-effective services.
- Conduct inpatient care coordination.
- Manage discharge planning processes.
- Handle post-acute clinical payer authorizations.
- Utilize InterQual and Milliman guidelines for reviews.
- Conduct concurrent and retrospective reviews.
- Manage appeals and denials.
- Ensure compliance with regulatory standards (CMS Department of Health The Joint Commission etc.).
- Perform CPT and ICD-10 coding and billing.
- Participate in data entry and documentation in EPIC.
- Answer phone calls and direct them accordingly.
- Coordinate equipment and supply needs.
Required Skills & Certifications:
- Current California Nursing license in good standing.
- BLS certification.
- Associates Degree in Nursing (ADN).
- Minimum of 2 years of direct patient care experience in an acute care setting.
- Knowledge of CMS CPT Department of Health DRG HEDIS HIPAA ICD-10 Coding NCQA OSHA The Joint Commission and Workers Compensation regulations.
- Current California Nursing license in good standing.
- BLS certification.
- Associates Degree in Nursing (ADN).
- Minimum of 2 years of direct patient care experience in an acute care setting.
- Knowledge of CMS CPT Department of Health DRG HEDIS HIPAA ICD-10 Coding NCQA OSHA The Joint Commission and Workers Compensation regulations.
Preferred Skills & Certifications:
- Bachelors Degree in Nursing (BSN).
- Certification in Case Management.
- Previous experience as a case manager in an acute care setting.
- Bachelors Degree in Nursing (BSN).
- Certification in Case Management.
- Previous experience as a case manager in an acute care setting.
Special Considerations:
- Must be willing to float.
- Must be willing to float.
Scheduling:
- 5x8 hour shifts 0730-1600 Monday through Friday weekends off.
- Block scheduling type.
- 5x8 hour shifts 0730-1600 Monday through Friday weekends off.
- Block scheduling type.
