CO2 welding technician

**THIS POSITION ID HYBRID in Orange, CA**

Job Summary

Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for members. The Medical Case Manager will facilitate communication and coordination amongst all participants of the health care team and the member to ensure that the services are provided to promote quality, cost-effective outcomes. The incumbent provides case management intervention on behalf of members with short term, stable, and predictable courses of illnesses. The incumbent is also responsible for answering the medical appropriateness, quality, and cost effectiveness of proposed hospital/medical/surgical services in accordance with established criteria. This activity may be conducted prospectively, concurrently or retrospectively.

Position Responsibilities

• Reviews and evaluates proposed services utilizing medical criteria and/or established policies and procedures. This includes review of submitted medical documentation and/or photographs.
  
• Determines the appropriate action regarding the service being requested for approval, modification, or denial, and refer to the Medical Director for review when necessary.
  
• Determines if the inpatient setting requested for surgery and/or medical care is appropriate. Identifies diagnosis and determine need for continuing hospitalizations and monitor the LOS as per established guidelines and professional judgment.
  
• Initiates contacts with patient, family and treating physicians as needed to obtain additional information or to introduce the role of case management.
  
• Analyzes all requests with the objective of monitoring utilization of services, which includes medical appropriateness and identify potentially high cost, complex cases for high level case management intervention.
  
• For short-term cases, conducts a thorough and objective assessment of the member s status including physical, psychosocial, environmental and gather all information pertinent to the case. Develops, implements and monitors a care plan through the interdisciplinary team process in conjunction with the individual member and family in internal and external settings across the continuum of care.
  
• Reports cost analysis, quality of care and/or quality of life improvements as measured against the case management goals.
  
• Routinely assesses member s status and progress; if progress is static or regressive determine reason and proactively encourage appropriate referrals to higher level of case management or makes appropriate adjustments in the care plan, providers and/or services to promote better outcomes.
  
• Establishes means of communication and collaboration with other team members, physicians, community agencies, and administrators.
  
• Prepares and maintains appropriate documentation of patient care and progress within the care plan.
  
• Acts as an advocate in the client s best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.
  
• Works collaboratively with staff members from various disciplines involved in patient care with an emphasis on interpreting and problem and solving complex cases.
  
• Documents case notes and rationale for all decisions in the Guiding Care system.
  
• Evaluate the quality of necessary medical services and be able to acquire and analyze the cost of care.
  
• Assist in the formulation of medical case management policies and procedures; understand and interpret policies, procedures, and regulations.
  
• Assess resource utilization, cost management, and negotiate effectively.
  
• Prepare clear, comprehensive written and oral reports and materials.
  

Requirements

Experience & Education

• Associates degree in Nursing (ADN); or equivalent work experience required.
  

• Current, unrestricted Registered Nurse (RN) license to practice in the State of California required.
  
  • 3 years of clinical experience with the health needs of the population served required.
    
  • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
    

Preferred Qualifications

• Bachelor s degree in Nursing (BSN) preferred.
  
• An active Commission for Case Manager (CCM) certification preferred.
  

Knowledge of:

• Guidelines and regulations relevant to case management and utilization management.
  
• Understand confidentiality and the legal and ethical issues pertaining to case management.
  
• ICD-9/ICD-10 and CPT coding requirements.
  
• Available community resources.
  
• Effective charting practices and guidelines.
  
• Available medical treatments and resources.
  
• Principles and practices of health care, health care systems, and medical administration.
  
• Computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
  

Benefits

At Sunshine Enterprise USA LLC, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:

Competitive pay & weekly paychecks

Health, dental, vision, and life insurance

401(k) savings plan

Awards and recognition programs

Benefit eligibility is dependent on employment status.

Sunshine Enterprise USA is an Equal Opportunity Employer Minorities, Females, Veterans and Disabled Persons