Case Manager I - PD - Days - Care Coordination-Patient Support @ MV

About the role

Case Managers are licensed nursing professionals who are responsible for care coordination, care transitions, discharge planning, and utilization review. Through use of evidence-based practices, effective communication and utilization of available resources, Case Managers work in collaboration with the interdisciplinary team to advance patients' care plan, ensure the appropriate level of care, and prevent unnecessary admissions and readmissions.

Responsible for promoting quality and cost-effective outcomes while assuring a positive patient experience. Has frequent contact with patients, families, physicians, nursing, interdisciplinary team members, quality, insurance companies, medical directors, post-acute providers, and community resources. Interprets regulations, health plan benefits, policies and procedures, and ensures compliance with federal, state, and local requirements.

Responsibilities

• Care coordination and transitions
• Discharge planning
• Utilization review
• Collaborate with interdisciplinary teams to advance patient care plans
• Ensure appropriate level of care and prevent unnecessary admissions/readmissions
• Promote quality and cost-effective outcomes
• Interpret regulations, health plan benefits, policies, and procedures
• Ensure compliance with federal, state, and local requirements
• Work with physicians, healthcare providers, discharge planning, and outside agencies regarding continued care/treatment or hospitalization
• Perform utilization management functions to ensure appropriate utilization of resources

Requirements

• Bachelor’s degree in nursing required
• Current California RN license
• Three years’ experience in the acute care setting and/or Case Management experience preferred
• Minimum 1 year experience in case management and/or managed care strongly preferred
• CCM (Certified Case Manager) or ACM (Accredited Case Manager) certification preferred
• Advanced communication skills in advocacy, negotiation, and conflict resolution
• Computer literate, with experience in word processing, data analysis, and presentation development

Skills

• Effective communication
• Advocacy, negotiation, and conflict resolution
• Utilization management
• Data analysis and presentation development

Pay

$93.87 - $122.62 USD per hour

Physical Requirements

• Sedentary work – duties performed mostly while sitting; walking and standing at times
• Occasionally lift or carry up to 10 lbs
• Uses hands and fingers

Ages of patients served: all age groups.