Managed Care Lead Case Management
Torrance Memorial Medical Center · 87500 - Case Management · $122k–$191k
Posted about 1 month ago
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Skills
Registered Nurse LicenseBLSACLSPeer ReviewProfessional DevelopmentUtilization ReviewDischarge PlanningBed utilizationQuality assessmentsChart reviewNursing careHealth plansRegulatory complianceCMS condition of Participation
Benefits
- ✓Health insurance
- ✓Learning budget
- ✓Remote stipend
Job description
The Lead Case Manager is responsible for assisting with the daily oversight of the hospital census to ensure effective and timely transitions of care. The Lead assists with the oversight of regulatory compliance processes and staff compliance with policies and procedures.
The Lead develops collegial relationships with the interdisciplinary team leads. The Lead educates case managers regarding health plans and regulatory changes related to transitions of care. This position provides feedback to staff to support well-coordinated care amongst the interdisciplinary team and post-acute providers. The lead monitors the length of stay to assist the team in securing authorization for the patient’s post-acute care through collaboration and communication with the health plan case managers and discharge planners. This position adheres to the CMS condition of Participation for Discharge Planning and other regulatory requirements
Core Competencies
- Participates in Peer Review, Professional Development activities and acts as preceptor..
- Provides patient and family education throughout the care of patient.
- Participates in activities in alignment with the Magnet Model.
- Complies with organizational quality dashboard benchmarking goals.
- Makes daily work assignments for each Case Manager.
- Attends Revenue cycle meeting monthly.
- Utilizes experience, in-depth knowledge to effectively modify and document changes in nursing care and/or the plan of care to address patient care problems and keep the primary care provider updated on any changes. Assesses health needs of patients using specialized knowledge skills and anticipates the outcome of interventions.
- Collaborates with the Utilization Review Nurse to expedite discharges and screen admission requests.
- Performs chart review and quality assessments as directed.
- Identifies inappropriate bed utilization and quality of care problems and refers them to Utilization Management physician advisor.
Education
DegreeProgramBachelorsNursing
Experience
Number of Years ExperienceType of Experience5Case ManagementAdditional InformationFive years clinical experience in an acute care facility.
License / Certification Requirements
Registered Nurse LicenseBLS or ACLS CertificationCompensation Range:
$58.54 - 91.82 / Hour
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