Case Management

Required: -CA RN-2 yrs experience -MUST have experience in ACUTE Case Management in California (excluding Kaiser) (Outpatient Case Management, Home Health or Health Plan Case Management experience will not suffice)!!M-F/no weekends/no callSKILLS

AND KNOWLEDGE: A broad knowledge base of health care delivery and case management within a managed care environment.Comprehensive knowledge of Utilization Review, levels of care, and observation status.Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems preferred.Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC.A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements.General understanding of coding and DRG assignment process preferred.Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.Demonstrates commitment to service excellence in all patients, family and employee interactions and in performing all job responsibilities.Functions in a manner to promote quality patient care and assure a positive patient experience.Strong verbal and written communication skills and negotiation skillsMust have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.Intermediate computer and technology skills.Ability to promote teamwork and to effectively function in teams.Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.

Modified Time: 11/24/2026 12:00:00

Flu Vaccine: Unknown Submittals:High

Job Requirements & Qualifications

Previous Charge Experience: - Years of Experience : Patient

Ratio Experience: Charting

System Experience: - Charting

System Name: Community

Hospital Experience: - LTAC Experience : - Trauma

Level I Experience: - Trauma

Level II Experience: - Travel