Are you looking for a great place to work in Los Angeles?
This may be the working environment for you!
Assignment is 8 hours, 5 days a week for a little over 3 months!
Unionized Hospital Organization.
Perm Placement guaranteed.
The RN Case Manager position carries consultative, educational and clinical responsibilities; the overall objective is to ensure the implementation of case management policies. Responsible for admissions, concurrent and/or retrospective reviews of all patients in accordance with the criteria and the policies and procedures approved by the Performance Improvement Committee, and consistent with Federal and State guidelines, PRO regulations, JCAHO standards and contractual agreements with insurers or outside review agencies. Serves as a liaison and promotes appropriate utilization. Collects, aggregates, displays and conducts first level analysis of data obtained from monitoring and evaluating the quality and utilization of patient care. Collaborates with Quality Mgmt and discharge coordinator regarding patient cases. Ensures appropriate reimbursement and authorizations from third party payors and their representatives for acute level patients. Educates the medical staff and other health care providers regarding proper documentation of rendered services. Supports the CQI process. Participates with HIM in the DRG collaboration process. Audit charts to meet Medicare requirements for skilled care. Responsible for processing Medi-Cal TARS and obtaining physical signature in a timely manner. Initiates the appeal process upon notification of denial by business office. Demonstrates knowledge of pediatric, adolescent, adult and geriatric variations in treatment/procedure as evidenced by annual age specific competency assessment/evaluation.
Current RN license in the State of CA and BCLS. BSN preferred. At least one year of recent experience in Utilization/Quality/Case Management in an acute setting.