Patient Care Coordinator/Case Manager - (US-CA-Hayward - 94557)

Minimum Education: None
Job Type: Full Time
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Responsibilities : Performs utilization management activities, discharge planning, and care coordination across the continuum of care in collaboration with the physician and other members of the health care team.

Requirements :Experience (usually 2 years) in direct patient care delivery and management. Demonstrated experience in utilization review, case management, and discharge planning preferred (usually 2 years). Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALAand all other applicable federal/state/local laws and regulations. Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgment abilities.Fundamental word processing and computer navigation skills, and the ability to interpret and use analytic data in day to day operations.Knowledge of healthcare benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).Baccalaureate preferred. Registered Nurse is required.Skilled Nursing, Home Health and/or Hospice is desirable. Experience using Interqual. Charge Nurse and previous case management and/or Utilization Review is desirable.Utilization ManagementPerforms daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately. Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives.Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care.Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care).Discharge PlanningEnsures 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.

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