JOB SUMMARY:
Case Managers function as liaisons between patients, their families, payors, and healthcare personnel to ensure appropriate movement along the continuum of care. Their focus includes coordinating discharge needs, quality of care, and implementing the utilization management process for acute inpatients. Case Managers perform concurrent review and denials management based on acute care guidelines with a focus on authorization and reimbursement, appropriateness of admission, length of stay, and avoidable delays in discharge. The Case Manager collaborates with the family, the care team, third party payors, and outside providers to coordinate discharge needs including home health, durable medical equipment, and safe transitions of care.
MINIMUM QUALIFICATIONS:
BLS for Health Providers (AHA)
California RN License
Bachelor's Degree in Nursing
4 years nursing in an acute hospital or 2 years Case Management, Utilization Review, or Discharge
Planning experience in an acute hospital
PREFERRED QUALIFICAITONS:
Experience in a pediatric acute hospital
Familiarity with Interqual or Milliman Care Guidelines
Experience navigating the electronic medical record (Epic)
The current salary range for this position is $59.73 to $97.42
A candidate’s placement in the range will be determined based on the terms and conditions of the applicable collective bargaining agreement. Rady Children’s Hospital is committed to being externally competitive and internally equitable. We demonstrate this commitment by reviewing market data to remain competitive within the nonprofit, healthcare sector. This posting will remain open from the “date posted” until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.