RN - CASE MANAGER (FT)

RN  -  CASE MANAGER   -  UTILIZATION REVIEW

• The Case Manager will assess admission necessity utilizing the ISSI criteria. Review date will be assigned. If treatment plan does not meet criteria, the UR nurse will refer case to attending physician. If no determination, the UR nurse will refer the case to the Medical Director.
• Initiates discharge planning per Department standard. All payor sources are screened for high risk, high volume and problem prone patients.
• Conducts interview with patients and significant others. Explores avenues of discharge planning.
• Demonstrates a knowledge of human behavior and counseling skills as they relate to patient and staff needs

•  Knowledge necessary to obtain RN license in the state of California and current California RN license.
• Three to five years experience in an acute care hospital setting preferred.
•  Broad knowledge of Medicare, Medi-Cal and insurance guidelines. Good written and verbal communication skills.