Acute Inpatient Nurse Case Manager

Imperial Health Plan of California, Inc.; Pasadena (CA); Presencial; USD 90.000 - 120.000; Jornada completa

Descripción de la vacante

Imperial Health Plan of California, Inc. is seeking an In-Patient Nurse Case Manager to oversee concurrent review and discharge planning for hospitalized patients, ensuring medical necessity, cost effectiveness, and timely services.

The role collaborates with Medical Directors, reviews records, coordinates referrals to Home Health Agencies, Skilled Nursing Facilities, and other resources, and maintains thorough documentation in patient records.

Formación

• Graduate of an accredited school of nursing.
• Minimum of 1 year of case management experience.
• Minimum of 1 year of managed care experience.
• Hospital inpatient or ambulatory case management experience preferred.

Responsabilidades

• Research issues using approved procedures for health care services and care for members.
• Review medical records for medical necessity and appropriate levels of care.
• Perform concurrent review and discharge planning within two working days of admission.
• Assess ambulatory referrals for medical appropriateness per guidelines.
• Refer cases not meeting criteria to Medical Director during rounds.
• Maintain records and statistics including bed days, discharges, readmissions, and diagnoses.
• Coordinate discharge planning with Home Health Agencies, SNFs, etc.
• Arrange placement in appropriate facilities.

Conocimientos

Medicare guidelines

HIPAA compliance

English proficiency

Confidentiality

Educación

Nursing degree

Descripción del empleo

Imperial Health Plan of California, Inc. is seeking an In-Patient Nurse Case Manager to oversee concurrent review and discharge planning for hospitalized patients, ensuring medical necessity, cost effectiveness, and timely services.

The role collaborates with Medical Directors, reviews records, coordinates referrals to Home Health Agencies, Skilled Nursing Facilities, and other resources, and maintains thorough documentation in patient records.