Job Description

Job Description

Job Description

PURPOSE:

The Inpatient Case Manager is primarily responsible for managing patients in the hospital and identifying high risk and high cost cases to be placed in Case Management.

ESSENTIAL DUTIES:

• Daily concurrent Review of medical records received justifying admission and continued stay at acute level of care according to the Milliman Care Guidelines.
• Review of each admission on daily census for appropriateness of admission based on diagnosis, correct hospital based on plan, correct Hospitalist assigned to the case, appropriate diagnosis codes, level of care, length of stay and member eligibility based on clinical criteria guidelines.
• Appropriate and timely in house denials issued for all admissions without authorization and/or without clinical review within 48 hours.
• Timely in house denials issued for administrative days once patient is medically stable to transfer to lower level of care.
• Transfer of all members to tertiary facilities for higher level of care when indicated.
• Evaluation of all out of network members for timely notification and stability to transfer in network.

MINIMUM REQUIREMENTS

• At least 3 years of clinical experience in an acute care setting
• Managed Care Inpatient case management experience preferred
• Knowledge of California’s federally funded healthcare programs: Medi-Cal, Medicare, Medi-Medi, and Covered California.
• Organized, efficient and possess superior attention to detail
• Punctual, prepared and able to meet or beat deadlines
• Excellent written and verbal communication skills

EDUCATION/TRAINING

• State licensure as Registered Nurse (RN) or Licensed Vocation Nurse (LVN)
• Bachelor's or Associate Degree in Nursing (Bachelor’s preferred)
• On-Site training will be provided

LANGUAGE SKILLS

• Ability to communicate and speak effectively before co-workers, management, and external contacts
• Ability to fluently speak, write, and understand English
• Ability to write routine emails and other correspondence
• Ability to speak clearly and concisely over the telephone

CONFIDENTIAL AND SENSITIVE INFORMATION:

• Must properly control the release of proprietary and confidential information

Note that the information above is intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.

Thrifty Management Services is the dedicated MSO for Preferred IPA of California, providing the best possible care management, care coordination, and claims processing services to Preferred IPA and their members. We work with the network’s participating physicians to coordinate patient care when a referral is made to a specialist or hospital for diagnosis and treatment. We coordinate patient care across all aspects of the provider network. We provide high quality services to its participating physicians and superior health care to its members.

Company Description

Thrifty Management Services is the dedicated MSO for Preferred IPA of California, providing the best possible care management, care coordination, and claims processing services to Preferred IPA and their members. We work with the network’s participating physicians to coordinate patient care when a referral is made to a specialist or hospital for diagnosis and treatment. We coordinate patient care across all aspects of the provider network. We provide high quality services to its participating physicians and superior health care to its members.

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