Inpatient Nurse Case Manager: Discharge & Care Coordination

Imperial Health Plan; Pasadena (CA); Vor Ort; USD 40.000 - 50.000; Vollzeit

Zusammenfassung

Imperial Health Plan in Pasadena, CA seeks a Nurse Case Manager to oversee concurrent review and discharge planning for hospitalized patients, ensuring medical necessity, cost-effectiveness, and timely care under Medicare/MCG guidelines.

You will coordinate with Medical Directors and care teams, review records, arrange referrals to Home Health, SNFs, Hospice, and maintain detailed documentation.

Qualifikationen

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

Aufgaben

• Conduct concurrent review and discharge planning for hospitalized patients.
• Coordinate services for medical necessity and cost effectiveness.
• Review medical records for medical necessity and appropriate care levels.
• Attend biweekly CM meetings and document activities.
• Arrange referrals to Home Health, SNFs, Hospice as needed.
• Maintain records and statistics on bed days, discharges, readmissions.

Kenntnisse

Medicare guidelines

Medi-Cal guidelines

Communication skills

Confidentiality

Multitasking

Regulatory compliance

Team collaboration

Ausbildung

Graduate of accredited nursing school

Jobbeschreibung

Imperial Health Plan in Pasadena, CA seeks a Nurse Case Manager to oversee concurrent review and discharge planning for hospitalized patients, ensuring medical necessity, cost-effectiveness, and timely care under Medicare/MCG guidelines.

You will coordinate with Medical Directors and care teams, review records, arrange referrals to Home Health, SNFs, Hospice, and maintain detailed documentation.