What are the responsibilities and job description for the Case Manager position at ARK Solutions?
Case Manager
Torrance, CA
13 Weeks contract
Torrance, CA
13 Weeks contract
Medical Center Case Manager / Utilization Review exp needed
REPORTING RELATIONSHIPS:
This position reports to the Director of Case Management. Accountability for the practice of nursing lies with the Senior Vice President of Patient Care Services. Utilization Review
PRIMARY DUTIES AND RESPONSIBILITIES:
1.Performs chart reviews and quality assessments on all patients and using (SI) Severity of Illness and (IS) Intensity of Service InterQual criteria as directed by Administration and the Medical Staff.
2.Emphasis on the identification and implementation of Case Management interventions that have less predictable outcomes
3. Monitors activity of 23 hour observation cases to see that the patient is appropriately discharged in a timely manner. If not makes sure the physician writes an order to admit the patient for inpatient services.
4. Initiates Medi-Cal TARs at time of admission or as soon as possible thereafter. Documents daily using SI and IS criteria.
5. Evaluates the Case Management Plan in a changing patient care situation for patient within the assigned work shift.
6. Educates physicians and appropriate hospital personnel regarding criteria for Utilization Management.
7.Provides documentation for denial letter and delivers denial letters to patients as directed by Utilization Management physician advisor.
8. Researches and prepares appeal for denial claims.
9. Uses Innovative problem solving skills in dealing with complex patient/significant other situations
10. Identifies inappropriate bed utilization and quality of care problems and refers them to Utilization Management physician advisor.
POSITION QUALIFICATIONS:
Current California RN license. Two years clinical experience. 2 years of Case Management experience and or certification in Case Management. Current BCLS certification.
Schedule:
Certifications: BLS
Salary : $122,000 - $154,000
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