Case Manager
3.
7 Quick Apply 13 hours ago Full Job Description Responsible for the utilization management process for all adult and geriatric psychiatric patient admissions to Behavioral Health Services, to include monitoring and assessing medical necessity for admission and continued stay.
Responsible for all aspects of the appeal process, compliance with DRG Prospective Payment timelines, collecting, entering, analyzing data and submitting reports, training of clinical staff to insure compliance with UM procedures, functions as a principal team member in the multidisciplinary case management team, coordinating discharge planning and the plan of care.
Coordinates a collaborative, well-shaped Behavioral Health Centralized Intake Service resulting in increased utilization and quality of Behavioral Health Services.
Responsible for implementing the Quality Management process for all Behavioral Health departments.
Ensures that patient care is documented accurately and appropriately and meets federal mandates, standards of practice, and established criteria.
Participates in Performance Improvement and Quality Management training at Palomar Health; completes medical record reviews, protecting the confidentiality of all information in accordance with department and hospital policies.
Supports Performance Improvement activities by collecting and analyzing information and data that support patient care.
Evaluates outcomes of patient care as required and prepares reports for medical staff and hospital committees.
Maintains working knowledge of current health care systems.
Participates as a team member of the clinical interdisciplinary team to ensure appropriate care, support and resources to all internal/external customers and displays on-going commitment to quality.
Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position.
Knowledge of standard office equipment (i.
e.
, calculator, fax, photocopier) and personal computer and computer software skills (i.
e.
, MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail).
Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job.
Performs other duties as assigned.
Follows Palomar Health rules, policies, procedures, applicable laws and standards.
Carries out the mission, vision, and quality commitment of Palomar Health.
Job Requirements Minimum Education:
As required by certification and/or licensure Preferred Education:
Bachelor's Degree in nursing Minimum
Experience:
2 years related experience Preferred
Experience:
5 - 7 years related experience Required Certification:
American Heart Association recognized BLS - Healthcare Provider Preferred Certification:
Not Applicable Required License:
Current CA RN License Preferred License:
Not Applicable Quick Apply.
Estimated Salary: $20 to $28 per hour based on qualifications.
7 Quick Apply 13 hours ago Full Job Description Responsible for the utilization management process for all adult and geriatric psychiatric patient admissions to Behavioral Health Services, to include monitoring and assessing medical necessity for admission and continued stay.
Responsible for all aspects of the appeal process, compliance with DRG Prospective Payment timelines, collecting, entering, analyzing data and submitting reports, training of clinical staff to insure compliance with UM procedures, functions as a principal team member in the multidisciplinary case management team, coordinating discharge planning and the plan of care.
Coordinates a collaborative, well-shaped Behavioral Health Centralized Intake Service resulting in increased utilization and quality of Behavioral Health Services.
Responsible for implementing the Quality Management process for all Behavioral Health departments.
Ensures that patient care is documented accurately and appropriately and meets federal mandates, standards of practice, and established criteria.
Participates in Performance Improvement and Quality Management training at Palomar Health; completes medical record reviews, protecting the confidentiality of all information in accordance with department and hospital policies.
Supports Performance Improvement activities by collecting and analyzing information and data that support patient care.
Evaluates outcomes of patient care as required and prepares reports for medical staff and hospital committees.
Maintains working knowledge of current health care systems.
Participates as a team member of the clinical interdisciplinary team to ensure appropriate care, support and resources to all internal/external customers and displays on-going commitment to quality.
Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position.
Knowledge of standard office equipment (i.
e.
, calculator, fax, photocopier) and personal computer and computer software skills (i.
e.
, MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail).
Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job.
Performs other duties as assigned.
Follows Palomar Health rules, policies, procedures, applicable laws and standards.
Carries out the mission, vision, and quality commitment of Palomar Health.
Job Requirements Minimum Education:
As required by certification and/or licensure Preferred Education:
Bachelor's Degree in nursing Minimum
Experience:
2 years related experience Preferred
Experience:
5 - 7 years related experience Required Certification:
American Heart Association recognized BLS - Healthcare Provider Preferred Certification:
Not Applicable Required License:
Current CA RN License Preferred License:
Not Applicable Quick Apply.
Estimated Salary: $20 to $28 per hour based on qualifications.
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