Job description

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives.

The Inpatient Case Manager position has a Monday-Fridayschedule, in the 1st shiftfrom 8am - 5pm. The pay is at $50/hr._ This is a fully remote/temp-to-hire_ position. An RN active unrestricted licese is required.

Job Duties:

• Effectively manage patients either telephonically or onsite during their hospitalization.
• Communicates effectively with facility staff and hospitalist to gather clinical information through verbal and written communications, and provides timely and accurate responses to request information or provide authorization decisions.
• Interacts with hospitalists and patients daily to evaluate plan of care including discharge planning.
• Applies medical knowledge to authorize outpatient services as an alternative to hospitalization when appropriate.
• Updates clinical information in the electronic medical management record system.
• _ Identifies cases not meeting criteria and provides clinical information and rationale to the Medical Director for review and determination._
• Actively participates in daily rounds with current and accurate clinical information.
• Effectively manage an average census of 20-25 patients at any given time.
• May be required to take After Hours On-Call pager coverage as assigned.
• Refers cases to the Medical Director as appropriate for denial of stay or review of potential observation status.
• May be responsible for timely development of denial letter language and member/provider notification regarding Medical Director’s review determination.
• Identifies and refers cases appropriately for CCS, High Risk, Homebound, Hospice/Palliative, SNF, QI and Health Education, per policy, and documents referral in case file. Identifies and reports departmental operational issues and resource needs to the appropriate identifiers.

Requirements:

• Active RN License
• Three to five (3-5) years experience in a medical group or Health Plan setting.
• Concurrent review experience, preferably in a managed care setting.
• Experience with Microsoft Office Word (50 WPM).
• Must be able to work Remotely.

Elite Workforce (323)537-8757

Job Type: Full-time

Pay: $50.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Application Question(s):

• Do you have an active RN license?

Experience:

• Inpatient Case Management: 1 year (Preferred)
• Concurrent Review: 1 year (Preferred)
• Discharge planning: 1 year (Preferred)

Work Location: Remote

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