+ Interprets and implements the facility’s Case Management Policy and Procedures.
+ Ensures facility compliance with federal and state regulations involving Case Management Practice.
+ Assures that patient receives quality patient care regardless of insurance coverage.
+ Utilizes InterQual –Screening criteria for all admissions and observation status patients.
+ Does the initial screening of all elective inpatient admissions related to:
+ Level of Care
+ Appropriateness of Admission
+ Discharge Needs
+ Third party contractual arrangements
+ Appropriate resource utilization
+ Documents patients admitted directly. Forwards the information on to the IPA/Insurance Case Managers as appropriate with discharge planning concerns and the initial discharge-planning screen
+ Current LVN license required.
+ Preferred Case Management experience utilizing MCG ( Milliman Care Guidelines ).
+ Ability to work independently and responsibly with minimal supervision.
+ Ability to interact and communicate with medical staff, hospital personnel, patients and families.
+ Ability to identify problems generates and analyzes feasible solutions and implements course of action.
+ Strong written and verbal communication skills.
+ Basic computer skills required.
+ Ability to be tactfully assertive and proactive in accomplishing job functions on time.
iCIMS Assigned Requisition ID: req18162
Facility Name: Whittier Medical Center
Shift: Days
External Company Name: AHMC Healthcare
Street: 9080 Colima Road