Acute Case Manager - (US-MI-Ann Arbor - 48113)

Minimum Education: None
Job Type: Full Time
Email this job to yourself or to a friend | Job Match Test | Resume Guide

Responsibilities : Coordinate and communicate discharge-planning needs with appropriate team members, medical personnel, members and their caregivers. Conduct after care follow up of members upon discharge to provide education and coordinate care as well as to assess the member's current health status. Analyze patterns of care that may be associated with progression to severe disease.  Conduct pre and post op assessments of specific members.  Identify contractual services and organize delivery through appropriate channels. Research and resolve issues related to benefits, member eligibility, non-elective and non-authorized services, coordination of benefits, and Mental Health and Substance Abuse care coordination. Actively promote communication between member, family, providers and all parties involved. Identify and document quality of care issues, and resolve, or route to Quality Management for handling. Follow out-of-area/out-of-network inpatient services and make recommendations on patient transfer to in-network facility and/or alternative plan of care. Develop and deliver education for provider community regarding policies, procedures, benefits, co-pays, etc. and medical management programs related to all product lines. Promote and engage in positive and constructive daily teamwork, participate in after hours call schedule, and perform other duties as needed.Registered Nurse with current, valid Michigan license required.

Requirements :Bachelor's Degree in nursing, allied health, business or related field preferred.Certification in case management preferred.Three (3) years of acute patient care with broad clinical background required.Two (2) years utilization review, discharge planning, case management, home care preferred in addition to the above.One (1) year experience in a managed care environment preferred.Managed care philosophy, policies, and proceduresApplication of clinical criteria/guidelines for medical necessity, setting/level of care, and concurrent patient management.

For more information of this job and to Apply Online, please visit us at http://www.employmentcrossing.com/lcjsjobdetail.php?akey=51f855a7bbcc15d883435b61fdfff88c

For more information please visit us at http://www.employmentcrossing.com