Job description

• Performs chart reviews and quality assessments on all patients and using (SI) Severity of Illness and (IS) Intensity of Service InterQual criteria as directed by Administration and the Medical Staff.
• Emphasis on the identification and implementation of Case Management interventions that have less predictable outcomes
• Monitors activity of 23 hour observation cases to see that the patient is appropriately discharged in a timely manner. If not makes sure the physician writes an order to admit the patient for inpatient services.
• Initiates Medi-Cal TAR’s at time of admission or as soon as possible thereafter. Documents daily using SI and IS criteria.
• Evaluates the Case Management Plan in a changing patient care situation for patient within the assigned work shift.
• Educates physicians and appropriate hospital personnel regarding criteria for Utilization Management.
• Provides documentation for denial letter and delivers denial letters to patients as directed by Utilization Management physician advisor.
• Researches and prepares appeal for denial claims.
• Uses Innovative problem solving skills in dealing with complex patient/significant other situations
• Identifies inappropriate bed utilization and quality of care problems and refers them to Utilization Management physician advisor.

Job Type: Contract

Pay: $65.00 - $72.00 per hour

Schedule:

• 8 hour shift
• Day shift

Application Question(s):

• COVID VACCINATION IS MUST

Education:

• Associate (Required)

Experience:

• Case management/Utilization Review: 2 years (Required)

License/Certification:

• BLS Certification (Required)

Work Location: In person

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