The RN Case Manager uses InterQual criteria to evaluate the
appropriateness of admissions, concurrent stay and readiness for
discharge. She/he assures correct level of care: critical,
telemetry, acute, observation, for all patients. The Case Manager
provides an efficient, coordinated approach to clinical management,
with an emphasis on discharge planning, care coordination and
utilization management activities for select patient populations
across the continuum of programs and services at AHMC. The
essential functions of the RN Case Manager require constant
collaboration with the Social Workers, Nursing staff, Financial
Counselors, Medical Staff to coordinate the care of patients in a
2 years Utilization Management/Case Management experience
preferred in acute care setting.
Working knowledge of Interqual, Intensity of Service/Severity of
Working knowledge of Title XVII and Title XIX.
Working knowledge of reimbursement related to Medicare,
Medi-Cal, Capitation, and Managed Care is required.
Ability to negotiate orders with the physicians in order to
assign alternate levels of care.
Working knowledge of community resources.
Working knowledge of methods to resolve patient needs such as
discharge planning, Home Health, DME and SNF's.
Ability to case manage smoothly and increase patient/physician
satisfaction while staying within guidelines.
Ability to track outcomes and report findings.
Able to problem solve effectively.
Ability to use clinical knowledge to identify potential quality
issues, delays in service, post-acute care needs required.
Must have excellent oral and written communication,
interpersonal, problem-solving, conflict resolution, presentation,
time management, positive personal influence and negotiation
Must have strong clinical assessment and critical thinking
skills necessary to provide utilization review/discharge planning
services appropriate to patients with complex medical, emotional
and social needs.
Must have the ability to work in a high volume caseload
environment and deal effectively with rapidly changing
Excellent computer skills with word, excel and power point.
RN License in the State of California required. BSN preferred.
Certified Case Manager preferred.