Case Manager, RN - Pre Access

About the role

The RN Case Manager-Pre Access is responsible for screening, coordinating, and facilitating admission review of all acute patients. They work collaboratively with all interdisciplinary staff to facilitate admission and transfer of patients, ensuring each patient meets established medical guidelines in collaboration with credentialed medical staff. They also communicate all requested and questionable admissions/transfers to the Director of Case Management, or Physician Advisor.

Responsibilities

• Screens, coordinates, and facilitates admission review of all acute patients
• Facilitates admission and transfer of patients
• Ensures each patient is admitted meeting established medical guidelines in collaboration with credentialed medical staff
• Communicates all requested and questionable admissions/transfers to the Director of Case Management, or Physician Advisor

Requirements

• Develops, maintains, and models professional, objective, and value-oriented interpersonal skills
• Maintains positive and proactive communication with patients, families, staff members, and physicians
• Fosters team-building relationships
• Excellent organizational skills and the ability to problem solve are essential
• Strong interpersonal skills, leadership, negotiation skills, and good leadership talent
• Knowledge of the payer industry, resource management, reimbursement, and evidence-based clinical practice is essential
• Understanding of State and Federal regulations; e.g., EMTALA, Medi-Cal, HMOs, etc.
• Understanding of Medicare, Medi-Cal, and other Third Party Payer regulations
• Understanding of current utilization/quality management principles, techniques, and procedures

Qualifications

• Licensure: Current CA RN license
• Certification: Current BLS provider card
• Case Management certification preferred

Skills

• Knowledge of the payer industry, resource management, reimbursement, and evidence-based clinical practice is essential
• Advanced experience utilizing InterQual required

Benefits

N/A

Pay

$51.31 to $78.76 per hour

Schedule

N/A