Case Manager
Company: Aerotek
Location: Oakland
Posted on: February 18, 2021
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Job Description:
Description:SUMMARY: Responsible for coordinating continuum of
care and discharge planning activities for a caseload of assigned
patients; develops plans of care and discharge plans, monitors all
clinical activities, makes recommendations for alternative levels
of care, and identifies cost-effective protocols. Care Management
provides Care Coordination, Compliance, Transition Coordination,
and Utilization Management.DUTIES & ESSENTIAL JOB FUNCTIONS: The
following are the duties performed by employees in this
classification, however, employees may perform other related duties
at an equivalent level. Not all duties listed are necessarily
performed by each individual in the classification.1. Coordinates
all utilization review functions, including response to payor
requests for concurrent and retrospective review information
including Medicare and MediCal regulations/requirements, avoidable
days and quality issues. Applies Medical necessity criteria to
determine level of care.2. Assures clinical interventions are
appropriate for the admitting diagnosis and Level of Care that
reflects the standard of care, as defined by the medical staff and
the organization; identify inappropriate admit status based on
identified criteria and ensures the patient is registered at the
appropriate level of care. Utilizes McKesson Interqual clinical
guidelines; refers questionable cases to the CM Manager or
physician advisor for determination.3. Takes appropriate action
when cases do not meet criteria. Escalates to the attending
physician, and the Care Management physician advisor of any
concurrent denial. Prepares case reports; documents treatment plan,
progress notes and discharge summary related information as
required by Medicare, MediCal, Title 22 and other mandated
regulations according to Department standards. Reassesses the
patient's condition when changes occur and revises the care plan
when appropriate.4. Develops, evaluates, and coordinates a
comprehensive discharge plan in conjunction with the
patient/family, physician, nursing, social work, and other
healthcare providers and agencies. Completes an initial assessment
within 24 hours of admission and documents findings in the
electronic health record. Processes referrals and authorizations
that adhere to federal, state and local insurance regulatory
agencies and offer patient choice per regulation.5. Identifies
potential problems prevents and or resolves barriers to the
discharge plan. Along with the social work team member6. Mobilize
resources to effect rapid and timely movement of the patient
through system to achieve targeted discharge times established.7.
Identifies and mobilizes patients and family strengths to optimize
use of healthcare and community resources. In coordination with
patient and family wishes, guide/assist in securing needed post
discharge services8. Collaborates with Care Management teams (i.e.
Care Transition team and CM teams at other facilities) for high
risk patients for timely follow-up appointments and confirms prior
to discharge that complex patients are appropriately linked to
community services.9. Provides community resource education and
coaching, focusing on individual patient self-management
principles. Ensures continuity of care through communication in
rounds and written documentation, level of care recommendations,
transfer coordination, discharge planning and obtaining
authorizations/approvals as needed for outside services for the
patient.10. Communicates with physicians and multidisciplinary
health team members to provide continuity of care, supporting and
maintaining the multidisciplinary team approach to ensure effective
resource utilization and appropriate level of care.11. Makes
independent assessments and recommendations regarding course of
action in complex situations.12. Confirm all applicable department
and regulatory targets for department performance process
improvements are attained (e.g., readmissions, throughput,
LOS).MINIMUM QUALIFICATIONS:Required Education: Associate Degree in
NursingRequired Experience: Three years of acute care nursing;
Emergency room experience.Preferred Experience: Medical/surgical or
critical care experience; broad clinical experience. Within the
last 3 years, experience in Case Management in an acute setting or
utilization review at a medical group or health plan.Required
Licenses/Certifications: Active licensure as a Registered Nurse in
the State of California, Active BLS - Basic Life Support
Certification issued by the American Heart Association; other
advanced life support certifications may be required per
unit/department specialty according to patient care policies; CPI
-Crisis Prevention Intervention Training.Preferred
Licenses/Certifications: Certification in Case Management, CCMC or
ACM. Bilingual Preferred.Skills:Case management, utilization
management, utilization reviewAdditional Skills &
Qualifications:Case ManagementExperience Level:Intermediate Level
About Aerotek:We know that a company's success starts with its
employees. We also know that an individual's success starts with
the right career opportunity. As a Best of Staffing Client and
Talent leader, Aerotek's people-focused approach yields competitive
advantage for our clients and rewarding careers for our contract
employees. Since 1983, Aerotek has grown to become a leader in
recruiting and staffing services. With more than 250 non-franchised
offices, Aerotek's 8,000 internal employees serve more than 300,000
contract employees and 18,000 clients every year. Aerotek is an
Allegis Group company, the global leader in talent solutions. Learn
more at Aerotek.com.The company is an equal opportunity employer
and will consider all applications without regards to race, sex,
age, color, religion, national origin, veteran status, disability,
sexual orientation, gender identity, genetic information or any
characteristic protected by law.
Keywords: Aerotek, Oakland , Case Manager, Executive , Oakland, California
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