We are looking for RN - Clinical Case Manager for our client in Sacramento, CA
Job Title: RN - Clinical Case Manager
Job Location: Sacramento, CA
Job Type: Contract - 12 Months / Contract to Hire / Direct Hire
- Start Date: 11/20/2017
- Shifts: ?Days M-F - 8am - 5pm
- Graduation from an accredited School of Nursing
- Possession of a current California RN License, BLS and 3 years recent and relevant CM/UR experience in an acute care setting
- Preferably experienced with EPIC and or ALLSCRPITS
- The department has the responsibility of hospital-wide Utilization Review and Discharge Planning, TAR, SDI Application Assistance and the Transfer Center and Admission Review unit. Through close departmental and interdepartmental interaction, the purpose is to reduce hospital costs, monitor length of stay and appropriateness of medical care in the acute setting, and ensure reimbursement through timely medical review and/or education of staff/physicians regarding appropriate levels of care. This position requires a high level of clinical judgment, creativity, organizational, and priority setting abilities
- A significant function of this position is to perform assessments of clinical information to determine medical necessity for the identified level of care, assessment of services provided and to promote optimal recovery of funding and appropriate utilization of resources.
- Clinical reviews for appropriate level of care and case status
- Manage denials from private and public payers and state and federal entities
- This includes but is not limited to HSAG, CMS, Private Insurances, State and Federal entities
- The UR CCM will analyze and review data, identify trends, write appeals, manage data entry functions and monitor for timely submission of all documents and communications
- Identification of findings and tracking of the following is necessary: Internal and external delays in service, patients who lack medical necessity for acute hospital admission, denials and appeals.