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Case Management Intermediate - (27794-1 WDH)
Woodland Hills, California | Contract
Wollborg Michelson is supporting a large healthcare company located in Woodland Hills and we are recruiting for a Case Management Nurse.
Working with complex cases promotes the delivery of quality; cost-effective health care services based on medical necessity and contractual benefits. Works with other members of HCS team, provider, hospitals, IPA/MGs, members and their families to plan and review medical necessity, intensity of services, level of care, length of stay and general appropriateness of care. Provides guidance to the provider network. Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care. May provide case management to member segments with chronic or catastrophic illness. Specific licensing requirements may apply depending upon position i.e. LVN, RN or Clinical Social Worker.
Ability to function as above
Discharge planning for cases that exceed EOA or dx assigned to RN.
Follow-up with LLC coordination such as SNF, HH, HI, Rehab.
Referrals to QM, DM, CM and AGD
IPA oversight, Continuity of Care, Healthy Families activities, OOA/OON cases, invest/exp, POS
Other CM activities as identified
Support to senior/lead CMs as needed. Ability encompasses broad knowledge of concepts, practices and procedures required within health care field.
Uses concepts and abilities as well as internal policies and procedures to complete assignments and solve problems.
Generally requires moderate to thorough experience in nursing, health care or related field. (3-5 years)
Generally requires a Bachelors degree or equivalent and appropriate licensing.