Medica Talent group is excited to share this full-timeopportunity with a leading healthcare company.
Title: RN Inpatient Case Manager
Position Type: Direct - Hire
Schedule: 8AM – 5PM, Monday to Friday
Location: Montebello, CA (Remote with the exception of on-site training)
Compensation: $50/hr
Responsibilities
1. Responsible for daily concurrent reviews, retro reviews, discharge planning, pre-certification/prior authorization request review, and ensures patients meet appropriate level of care based on acceptable evidence-based Clinical Criteria(s). (Interqual and / or Milliman)
2. Follows established policies, procedures, workflows, and desktop procedures of the department.
3. Effectively and efficiently manages patients throughout the continuum of care.
4. Works collaboratively with hospitalists, hospital partners, and care teams to provide holistic patient care that is focused on high quality in a cost effective way.
5. Develops a working relationship with the hospital case managers, health plan, clinics, hospitalists and other governing entities.
6. Works with hospital discharge planners and assists in the coordination of support services.
7. Rounds and reports daily with Regional Medical Director, RN Leadership, and hospitalists to collaborate on Plan Care and Discharge Plan.
8. Rounds and reports daily catastrophic cases (>10days) and full, dual, and shared risk patients to RMDs and RN Leadership
9. Attends Joint Operation Meetings (JOM) meetings and various community meetings as needed.
10. Responsible for the daily review and processing of referral authorizations in accordance to turnaround time (TAT) standards set by ICE/Health Plan requirements.
11. Assists in performing and documenting patient outreach telephonic and/or face to face to ensure safe, appropriate discharge planning to reduce the likelihood of readmissions and responsibilities includes but not limited to PCP appointments, ensure DME Home Health is ordered, referring for social barriers for referrals to social workers.
12. Performs other related duties as assigned.
13. Responsible for performing necessary assessments to provide adequate patient care.
14. Responsible for formulating an appropriate and safe transition of care plan to the next level of care.
15. Responsible for ensuring discharge plan is obtained and communicated / forwarded to PCP and/or next level of care provider.
Qualifications
1. Graduation from an accredited nursing program.
2. Current valid License as a Registered Nurse through the California Board of Registered Nursing; Bachelor’s degree in nursing, or another health or human services field with the appropriate licensure preferred.
3. Experience in and willingness to be part of multi-disciplinary team.
4. Experience with physically or mentally impaired adults and/or geriatric population.
5. Three years RN experience in public health nursing, acute care, case management and/or home health care required; minimum of 2 years of managed care experience in case management with focus in inpatient and/or outpatient ambulatory care preferred.
Job Type: Full-time
Pay: From $50.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Parental leave
- Retirement plan
- Tuition reimbursement
- Vision insurance
Schedule:
Work setting:
Application Question(s):
- This position is remote with the exception of onsite training. Are you open to completing training in Montebello, CA for the initial 4 - 8 weeks?
Experience:
- Case management: 2 years (Required)
- Nursing: 3 years (Preferred)
License/Certification:
Ability to Commute:
- Montebello, CA 90640 (Preferred)
Ability to Relocate:
- Montebello, CA 90640: Relocate before starting work (Required)
Work Location: Hybrid remote in Montebello, CA 90640