The scope of duties encompasses a variety of tasks related to performing the following: integrated concurrent review for utilization; quality and risk; discharge planning; and case referrals for patients. This position works with medical and professional staffs to obtain appropriate clinical documentation for review and to meet inpatient criteria by the Interqual Guidelines. The Case Managers are responsible for the research and appeal UR denials; micro management of patients to ensure appropriate and timely resource utilization; timely and accurate communication to insurance utilization review for certification of admission and continued stay. This position also coordinates patients care with an interdisciplinary team; screens and coordinates authorization of requests for capitated services for all assigned managed care where the hospital has a financial responsibility.
Current license as a Registered Nurse in California, or related health care professional.
Three years Case Management/UM experience in an acute care facility;
Knowledge and experience with Medi-Cal preferred
Good communication skills and ability to work with others;
Basic computer skills
Job: Case Management/Home Health
Primary Location: Indio, California
Facility: John F. Kennedy Memorial Hospital
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâs or employeeâs race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.