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RN (Registered Nurse) Case Man...

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Job Summary

Company
Managed Care Resources (MCR)
Location
Whittier, CA
Industries
Healthcare Services
Job Type
Full Time
Employee
Years of Experience
2+ to 5 Years
Education Level
Associate Degree
Career Level
Experienced (Non-Manager)
Contact Information
Managed Care Resources (MCR)
Phone:  310-470-4232
Fax:  310-475-4737

RN (Registered Nurse) Case Manager - Hospital, Inpatient

About the Job

  1. Hospital, Inpatient
  2. RN Case Manager / Care Coordinator


The Job:

  • Concurrent Review
  • Utilization Review
  • Discharge Planning
  • Authorizations (TARS)
  • Case Management from Admission to Discharge

 

Ability to:

  • Responsible for assessing, planning, implementing, and evaluating the needs of patients for discharge planning and utilization review.
  • Level of Care, Length of Stay, Continued Stay Reviews
  • Coordinate utilization management, care facilitation, and discharge planning
  • Coordinate discharge planning with physicians, nursing, and social services, patient and significant others.
  • Review patient procedures and DRG status against criteria for Medicare, Medi-Cal, and other insurance coverage.
  • Perform chart reviews and quality assessments on all patients and using severity of illness(SI) and intensity of service (IS) InterQual criteria
  • Precertification and Prior Authorization.

  • Knowledge of:

        • DRG and ICD-9 and CPT coding, requirements for prior approval.
        • Available community resources.
        • Effective charting practices and guidelines.
        • JCAHO Standards and Title XXII Regulations
        • Reimbursement related to Medicare, Medi-Cal & Managed Care


    Requirements:
    • California Nursing License (RN)
    • 2+ years of Experience




    About the Agency:

    Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information!
     

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