Job Description
The Inpatient/SNF Case Manager is responsible for coordination of daily Inpatient/SNF services including assessments, treatment planning, monitoring, evaluation, documentation and discharge planning function in accordance with CRC policies, procedure and processes. Interacts with the Medical Directors, facility staff and hospitalists on a daily basis to determine medical necessity of admission, continued stay or any discharge planning needs. On Call rotation for non-business hours, weekends and holidays. **
Responsibilities**
Qualifications
Three to five (3-5) years’ experience in a Medical Group or Health Plan setting with strong clinical skills and critical thinking. Four (4) years of experience in a managed care setting. Experience with Microsoft Office Word required. Recommend but not required, knowledge of NCQA, Medicare, Health Plan, DHS and State standards and other regulatory requirements. Make independent decisions. Knowledge of nationally recognized criteria InterQual, etc. Maintains strong working relations with internal and external customer. Effectively articulates clinical and non-clinical information to persons of all levels. Communicates positively and effectively. Maintains member confidence and protects operations by keeping claim information confidential in compliance with HIPPA requirements.Graduate of accredited nursing programRN active unrestricted license.
Go Premium: Access the World's Largest Selection of Remote Jobs!