Case Manager FT Days

Socket.dev; Santa Ana (CA); On-site; USD 94,000 - 119,000; Full time

Benefits offered by this job

Benefits package

Job summary

Kindred Hospital Santa Ana, part of ScionHealth, seeks a Care Coordination professional to optimize patient flow across the continuum of care. You will work with the interdisciplinary team to align care plans, coordinate services, and support discharge planning for optimal resource use.

You will review medical necessity, collaborate with payors, and ensure regulatory compliance while maintaining exceptional patient and family communication throughout the hospital stay.

Qualifications

• Knowledge of government and non-government payor practices and reimbursement.
• Fluent English with strong communication.
• Basic computer skills with Word/Excel.
• Healthcare experience in case management a plus.

Responsibilities

• Coordinate clinical and psycho-social activities with the interdisciplinary team and physicians.
• Assist with care coordination and referrals for high-risk patients.
• Conduct comprehensive discharge planning and timely transitions.
• Perform medical necessity reviews from admission through discharge.
• Participate in rounds, committees, and interdisciplinary collaboration.

Skills

Payor practices and reimbursement

Medicare knowledge

Communication skills

Interpersonal skills

Office software

Education

LPN/LVN or RN

MSW with licensure or BSW with licensure

Tools

Microsoft Office

Job description

Kindred Hospital Santa Ana is a long-term acute care hospital offering the same in-depth care you would receive in a traditional hospital, but for an extended recovery period. We partner with your physician and offer 24-hour clinical care seven days a week so you can start your journey to wellness. We are conveniently located between the Santa Ana Freeway I-5 and Santiago Creek and the close to many shops and restaurants.

Job Summary

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.

Essential Functions

Care Coordination

• Assist in coordinating clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Assists with effective care coordination and efficient care facilitation.
• Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
• Appropriately refers high risk patients who would benefit from additional support.
• Serves as a patient advocate.
• Knowledgeable of the principles of growth and development over the life span and the skills necessary to provide age-appropriate care to the patient population served.
• Participates in interdisciplinary patient care rounds and/or conferences.
• Collaborates with clinical staff in the execution of the plan of care, and achievement of goals.

Discharge Planning

• Under appropriate supervision, conducts comprehensive, ongoing assessment of patients and family to provide timely and safe discharge planning.
• Assists with comprehensive discharge planning.
• Utilizes critical thinking to execute effective discharge planning.

Utilization Management

• Conducts medical necessity review for appropriate utilization of services from admission through discharge.
• Promotes effective and efficient utilization of clinical resources.
• Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor.

Other

• Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• Serves on Hospital and Division committees when requested.

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Must read, write and speak fluent English.
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers
• Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
• Must have regular attendance.
• Approximate percent of time required to travel, 0%25.
• Performs other related duties as assigned.

Pay Range: $94K-$119K/yr.

ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness.

Education

• Graduate of an accredited program required: LPN/LVN or RN.
• Master of Social Work with licensure as required by state regulations or Bachelor of Social Work with licensure as required by state regulations.

Licenses/Certifications

• Healthcare professional licensure required as LPN/LVN, Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.

Experience

• One year of experience in healthcare setting.
• Experience in case management, utilization review, or discharge planning a plus.