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Hospital Case Manager Registered Nurse (RN)

Company: Yoh Staffing Services
Location: Fullerton
Posted on: January 27, 2019

Job Description:

Hospital Case Manager Registered Nurse (RN) needed for a full-time, long-term opportunity with Yoh's client located in Van Nuys, CA

Top Skills You Should Possess:


  • Registered Nurse license in state of California
  • Bachelor of Science degree in Nursing is required
  • Minimum of three-five (3-5) years' experience as a Registered Nurse in an acute care setting preferably in a critical care unit
  • Minimum of two-three (2-3) years' of recent experience as a Case manager in an acute care setting
  • InterQual guidelines knowledgeable is required.
  • Must be able to demonstrate the knowledge and skills necessary to provide appropriate case management specific to the age of the patients served on assigned units. Case Managers are assigned patients ranging in age from neonates to geriatrics.


    What You'll Be Doing:


    • Independently performs daily concurrent chart reviews on all assigned patients utilizing approved hospital criteria (Medi-Cal and managed care patients require daily review regardless of criteria recommendation).
    • Proactively call/fax daily concurrent chart reviews to managed care companies (MCO)/medical groups according to payor contract/hospital policy. Document the review was called/faxed to MCO/medical group and document the dates approved for continued stay on the review record. Ensure MCO/medical group review call-in and approval dates are entered in the Meditech System to avoid payor denials.
    • Independently performs timely retrospective chart reviews on all assigned patients utilizing approved hospital criteria. Perform managed care reviews within 24 hours of notice and TAR reviews with 24 hours of notice
    • Document concurrent TAR reviews daily. Complete retrospective TARs within five (5) business days of notification
    • Refers cases not meeting criteria (including situations involving the timely provision of services) to Physician Advisor or Medical Director as appropriate.
    • Obtains authorizations as required by third party payors for patients whose insurer has such requirements.
    • Facilitates transfer of patients to other acute care facilities as required either due to third party payor requirements or county mandated indigent program.


      What You Need to Bring to the Table:


      • Flexibility to work Monday-Friday 8:00 am to 5:00pm
      • BLS/CPR certified from AHA
      • Registered Nurse License in State of CA
      • BS Degree in Nursing is required
      • Must have updated MMR/Varicella Titres, Physical, PPD and Flu vaccinations.


        --

        Keywords: Yoh Staffing Services, Fullerton , Hospital Case Manager Registered Nurse (RN), Executive , Fullerton, California

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