Experienced Case Manager

divh2Case Manager/h2pQualifications for Case Manager:/pulliThe Case Manager is responsible for managing a continuum of care from admission through discharge for assigned patients./liliPartners with medical staff, utilizes scientific evidence for best practices, relevant data and compliance with the mission/philosophy, standards, goals and core values./liliParticipates in the development of patient focused long/short term goals, implementing, evaluating and modifying the care plan./liliCollects and reports utilization data and quality information, such as delays in service, possible avoidable days, provider preventable conditions, readmissions, and length of stays, etc./liliAssists in preparing UM/QI case issues, gathering requested records/responses./liliConsults with the nursing staff working directly with clients in the nursing care areas./liliMaintains current knowledge of evidence based nursing care practices./liliEducates nursing staff about state and federal rules and regulations in preparation for accreditation./liliEvaluates and verifies employee performance through the review of completed work assignments and work techniques./liliEnsures delivery of quality care to patients, enhancement of business development, and continuous improvement of agency efficiency and fiscal success./liliProvides instruction to hospitalized members and their families; and serves as liaison between the member, the physician, the hospital and the Plan./liliCase Manager completes appropriate, accurate and timely, documentation into EMR system every shift/li/ulpRequirements for Case Manager:/pulliActive CA Registered Nurse/liliAcute clinical experience/liliExperienced in case management, UR/UM/liliPossesses knowledge of applicable regulatory standards and is able to perform audits based upon these standards/liliSolid experience dealing with UR concepts/liliComputer literate/li/ulpExcellent verbal and written communication skills/p/div