Case Manager II

Talentify; Paramount (CA); On-site; USD 7,052,000 - 8,954,000; Full time

Job summary

Kindred Hospital Paramount and Acute Rehabilitation Unit (ARU) is seeking a care coordinator to optimize patient management across the continuum of care. You will collaborate with the ICT team and physicians to ensure appropriate resource utilization and effective discharge planning.

The role emphasizes patient advocacy, knowledge of payor practices, and adherence to regulatory standards, with a focus on high-quality, cost-effective care in an acute rehabilitation setting.

Qualifications

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Ability to demonstrate critical thinking, prioritization and time management.
• Excellent interpersonal, verbal and written communication skills.

Responsibilities

• Coordinate care with the Interdisciplinary Team and Physicians.
• Monitor patient stays for effective coordination and discharge planning.
• Conduct medical necessity reviews and utilization management from admission to discharge.
• Participate in committees and ensure compliance with policies and standards.

Skills

Case management

Interdisciplinary teamwork

Communication

Critical thinking

Microsoft Office

English fluency

Education

RN (BSN preferred)

MSW/BSW licensure per state

Job description

Description

Kindred Hospital Paramount and Acute Rehabilitation Unit (ARU) is 177-bed hospital. With 159 long-term acute care hospital (LTACH) beds, we offer the same in-depth care you would receive in a traditional hospital, but for an extended recovery period. Our 18-bed ARU is designed for people who have experience the debilitating effects of an acute injury, impairment or illness and like the LTACH, we partner with your physician and offer 24-hour clinical care seven days a week so you can start your journey to wellness.

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

• Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Monitors all areas of patients' stay for 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. Enhances a collaborative relationship to maximize the patient's and family's ability to make informed decisions.
• Demonstrates knowledge 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 to review treatment goals, optimize resource utilization, provide family education and identified post hospital needs. Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals.
• Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients' care throughout the care continuum.

Discharge Planning

• Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning.
• Provide comprehensive discharge planning for each patient. Utilizes critical thinking to develop and execute effective discharge planning.
• Coordinate and communicates with patient/family efficient and effectively.

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.
• Ability to demonstrate critical thinking, appropriate prioritization and time management skills.
• 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.
• Approximate percent of time required to travel: 0%
• Must read, write and speak fluent English.
• Must have good and regular attendance.
• Performs other related duties as assigned.

Pay range: $51.19 - $64.92/Hr
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.

Qualifications

Education

• Graduate of an accredited program required for RN.
• BSN preferred or MSW/BSW with licensure as required by state regulations

Licenses/Certifications

• Healthcare professional licensure required as Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.
• Certification in Case Management a plus.

Experience

• Two years of experience in a healthcare setting preferred.
• Prefer prior experience in case management, utilization review, or discharge planning.