Provides utilization review and discharge planning for a patient population, coordinates safe care transitions, communicates with payers to reduce denials and readmissions, and meets assigned goals and regulatory requirements.
Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
- Utilization Review
- Discharge planning
- Readmission Reduction Participation
- Payer Communication and denial reduction
- Completes assigned goals.
Specifications
Experience
Minimum Required
- RN with at least one (1) year of clinical experience
Preferred/Desired
- RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Education
Minimum Required
- Diploma or Associate Degree in Nursing
Preferred/Desired
- BSN or MSN
Training
Minimum Required
Preferred/Desired
- Certified Case Manager
Special Skills
- .
Minimum Required
- Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
Preferred/Desired
- Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
Licensure
- RN
Minimum Required
- RN
Preferred/Desired
- RN;CCM;ACM
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Los Angeles is a global leader in entertainment, so it’s no surprise that many of the biggest players in streaming, digital media and game development call the city home. But the city boasts plenty of non-entertainment innovation as well, with tech companies spanning verticals like AI, fintech, e-commerce and biotech. With major universities like Caltech, UCLA, USC and the nearby UC Irvine, the city has a steady supply of top-flight tech and engineering talent — not counting the graduates flocking to Los Angeles from across the world to enjoy its beaches, culture and year-round temperate climate.
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- Number of Tech Workers: 375,800; 5.5% of overall workforce (2024 CompTIA survey)
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- Research Centers and Universities: California Institute of Technology, UCLA, University of Southern California, UC Irvine, Pepperdine, California Institute for Immunology and Immunotherapy, Center for Quantum Science and Engineering
