LVN- Case Manager - Ambulatory Care - Hybrid

Why work here? Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b), we take pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation. Primary Duties and Responsibilities Meets with patients within 24 hours of admission and conducts an initial assessment. Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patient’s stay. Reviews with hospitalist the patient’s admission and continued stay for medical necessity, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary. Begins discharge planning and care assessment within one working day (preferably on day of admission). Submits necessary clinical information to the health plan using the accepted format (MIDAS or telephonic) and coordinate health plan communication with assigned hospitalist as appropriate. For patients who are transitioning to the Skilled Nursing Facilities, refers to nurse practitioner and case manager assigned to the SNF’s for continued review and follow up. Authorizes all appropriate services based upon covered benefits and necessity of care provided. Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate. Coordinates the patient’s care with other health care personnel to ensure that the patient receives care timely post discharge. Secures outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers. Refers to Ambulatory Case Manager patients identified that will need oversight of outpatient care and compliance to avoid unnecessary readmissions. Coordinates referrals and secure appointment with various CSMNS disease management programs. Enters and updates all authorization and clinical information into Nautilus (Access Express) no later than date of discharge. #J-18808-Ljbffr Case Management Society of America (CMSA) ®