RN - Case Manager

RN - Case Manager

Shift: Day 5x8-Hour (08:00 - 16:30)

Coordinates the utilization management, resource management, discharge planning, post-acute care referrals, and care facilitation. Oversees the management of acute patient populations across the care continuum with a focus to provide coordinated and integrated care to prevent unnecessary admissions or readmissions. Provides discharge planning coordination and intervention for the high-risk patient presenting to the Emergency Department. Strives to promote patient wellness, improved care outcomes, efficient utilization of health services, and minimized denials of payment among a patient population with complex health needs.

Required Certifications: CA RN License, BLS

Skills: Acute Hospital, Admission Criteria, Appeals and Denials, Benefits Eligibility, Care Coordination, CMS: Centers for Medicare and Medicaid Services, Continued Stay Reviews, CPT (Current Procedural Terminology) coding and billing, Department of Health, Determine Medical Necessity per Evidence-Based Guidelines, Disability Case Management, Discharge Planning, Disease Management, DRG (Diagnosis Related Groups), Emergency Department, HIPAA Guidelines (Health Insurance Portability and Accountability Act), ICD 10 Coding, ICU, Long Term Acute Care/Rehab/Skilled Nursing, MS, Needs Assessment/Order DME, Pediatrics, Plan of Care, Surgical Services, The Joint Commission/Core Measure/National Safety Goals, Worker’s Comp Case Management, Workers Compensation

Compliance: Onboarding: Must complete labs within 3-5 days of contract signing. Work History Verification: 7-Year Work History Verification Required for all candidates. Candidates must provide accurate work history information going back 7 years from their start date and may also be required to provide documentation or contacts for the verifications if we are unable to verify any positions. Deadline: All compliance documents due 10 days prior to start. Modules: Modules are non-billable. An average of 1-5 hours spent on modules and are factored into NBO. Any time spent on modules exceeding the 16 NBO hours are billable. Modules are completed during orientation, and module hours vary by specialty. Modules are recorded through e-learning.

Client Details: Address 785 W Washington Blvd, City Crescent City, State CA, Zip Code 95531