Case Manager (Full-Time)

Qualifications

• Experience
• Previous C.M. Experience
• Substantial clinical experience
• Education
• Bachelor's degree (required)
• Masters (preferred)
• Licensing
• Foreign Medical Graduate or Registered Nurse (preferred)
• CCM (Certified Case Manager) (preferred)
• ACM (Accredited Case Manager) (preferred)
• Bilingual (English/Spanish) (preferred)

Responsibilities

• Performs and documents patient assessment within 24 hours of admission
• Checks prior authorizations initiative by admitting
• Knowledge navigating and using payer portals
• Performs concurrent reviews
• Contacting all HMO’s on a daily basis and provides clinical information to obtain insurance authorization for the patient’s admission and continued stay
• Indicates the appropriate level of care and utilization of services needed
• Establishes criteria for medically necessary services
• Knowledgeable of Milliman Care and Interqual Guidelines
• Develops a plan of care for patients from admission to discharge.
• Promotes the most efficient and cost-effective use of services
• Curtails the performance of inappropriate and/or duplicate services
• Encourages standardization of medical practice patterns
• Enhances the quality of healthcare
• Performs concurrent reviews for patients to ensure that extended stays are medically justified and are documented in patient's medical records.
• Calculates and manages the lengths of stay and continued-stay days for patients.
• Evaluating the patient’s condition and readiness for discharge planning
• Develops discharge plans
• Communicate and assist the physicians in the planning and coordination of patients discharge planning
• Management of transfer procedures