Concurrent Review Case Managers Needed

Case Managers are vital to the care of our clients – come join us and make a difference!    Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for our members. This position provides case management intervention on behalf of members with short-term, stable and predictable course of illnesses. Also responsible for answering the medical appropriateness, quality, and cost effectiveness of proposed hospital/medical/surgical services in accordance with established criteria. This activity may be conducted prospectively, concurrently, or retrospectively. - Review and evaluate proposed services utilizing medical criteria and/or established policies and procedures. This includes review of submitted medical documentation and/or photographs. - Determine the appropriate action with regard to the service being requested for approval, modification or denial, and refer to the Medical Director for review when necessary. - Determine if the inpatient setting requested for surgery and/or medical care is appropriate. - Initiate contacts with patient, family, and treating physicians as needed to obtain additional information or to introduce the role of case management. - Analyze all requests with the objective of monitoring utilization of services, which includes medical appropriateness and identification of potentially high cost, complex cases for high-level case management intervention. - For short-term cases, conduct a thorough and objective assessment of the member’s current status including physical, psychosocial, environmental, and gather all information pertinent to the case. - Report cost analysis, quality of care and/or quality of life improvements as measured against the case management goals. - Routinely assess member’s status and progress; if progress is static or regressive determine reason and proactively encourage appropriate referrals. - Prepare and maintain appropriate documentation of patient care and progress within the care plan. - Act as an advocate in the client’s best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. - Work collaboratively with staff members from various disciplines involved in patient care with an emphasis on interpreting and problem and solving complex cases. - Document case notes and rationale for all decisions in the CCMS system. - Other projects and duties as assigned. - Current RN license to practice in the state of California is required. - Bachelor’s degree preferred. - 5 years minimum clinical experience with the health needs of the population served. - Ability to work toward and/or maintain case management certification (CCM) - ICD-9/ICD-10 and CPT coding requirements. If you feel that you have the skills we require, please respond to this posting with your contact information and your resume in a Word document. We look forward to hearing from you today! www.healthcaretalent.net https://www.facebook.com/HCTalent