Case Manager

Job Description

We are seeking a dedicated Case Manager with experience in acute care case management and discharge planning. The successful candidate will be involved in various aspects of patient care coordination and will support the healthcare team in delivering optimal patient outcomes.

Key Responsibilities

• Coordinate patient admissions, care plans, and discharge processes.
• Assess patient needs and determine medical necessity following evidence-based guidelines.
• Conduct family meetings to discuss treatment plans and patient progress.
• Ensure compliance with CMS and HIPAA guidelines throughout the care continuum.
• Work collaboratively with interdisciplinary teams to deliver comprehensive patient care.
• Utilize InterQual and other relevant criteria for assessments and care coordination.
• Manage requests for prior authorizations and arrange for medical equipment, skilled nursing facilities, and transportation as needed.

Qualifications

• Minimum of 2 years of experience in acute care case management or discharge planning.
• Demonstrated knowledge of care coordination and admission criteria.
• Experience with Medicare, Medi-Cal, and various health insurance plans.
• Ability to manage care for diverse patient populations, including neonates, pediatrics, adults, and geriatrics.
• Strong communication and organizational skills.
• CA state license required; pending license accepted with provision for licensing upon start date.

Work Schedule

• Full-time position, dayshift.
• Availability for every other weekend and holidays is required.
• Must be open to floating between sister facilities as necessary.

Special Requirements

• Complete screening for first-time travelers.
• No more than 7 days of requested time off.
• Competence in computerized documentation is mandatory.

Patient Demographics

The role will involve working with a varied patient demographic, including those experiencing behavioral health challenges, homelessness, and substance abuse issues.

Additional Information

It is essential for the candidate to have a solid understanding of treatment options available for patients in unique circumstances and the ability to participate actively in their care planning and discharge processes.