Case Manager - Per Diem
To perform this job successfully, an individual must have and maintain current licensure as a Registered Nurse in the state of California. BSN required or must be actively enrolled and obtain BSN within 2 years of hire. Have one year or more experience as an RN in an Acute Care setting. Prefer two years of experience as a RN Case Manager. Certification in Case Management desirable. Must have and maintain current BLS certification or obtain within orientation process, prior to hands-on patient care.
Under the direction of the Director of Case Management, uses pre-established guidelines and criteria to perform review activities assuring proper utilization of hospital resources for Medicare, Medi-Cal, HMO’s and other third party payers. Takes appropriate follow up action when established criteria for utilization of services are not met, in order to assure that denials are avoided. Identifies medically indigent patients and monitors closely to assure that appropriate placement is secured; works with patient and family to determine if other sources of funding may be applicable. Maintains appropriate documentation of review performed, according to pre-established criteria, indicating severity of illness and intensity of services rendered with acute/ post-acute hospitalization. Acts as liaison with physician(s) to ( 1) assure all covered aspects of treatment are fully document, and (2) assist in identifying other options for care when patient no longer require acute hospitalization, securing appropriate referral for social services, discharge planning and home health services, and long-term care placement.
Must be able to work flexible hours as defined by the needs of the departments.
Needs to recognize that they have an affirmative duty and responsibility for reporting perceived misconduct, including actual or potential violations of laws, regulations, policies, procedures, or this organization’s standards/code of conduct.
The employee shall work well under pressure, meet multiple and sometimes competing deadlines and the employee shall at all times demonstrate a cooperative behavior with colleagues and supervisors.
The Hospital is an equal opportunity employer and makes employment decisions on the basis of merit, qualifications, potential and competency. The Hospital policy prohibits unlawful discrimination based on race, color, creed, gender (including gender identity and gender expression), religion (all aspects of religious beliefs, observance or practice, including religious dress or grooming practices) marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition (including cancer or a record or history of cancer, and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, veteran status or any other consideration made unlawful by federal, state, or local laws. It also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics, or is associated with a person who has or is perceived as having any of those characteristics. Discrimination can also include failing to reasonably accommodate religious practices or qualified individuals with disabilities where the accommodation does not pose an undue hardship. All such discrimination is unlawful.
The Hospital is committed to complying with all applicable laws providing equal employment opportunities. This commitment applies to all persons involved in the Hospital operations and prohibits unlawful discrimination by any employee of the Hospital, including supervisors and coworkers.