Summary: The scope of duties encompasses a variety of tasks related to performing the following: integrated concurrent review for utilization; quality and risk; discharge planning; and case referrals for patients. This position works with medical and professional staffs to obtain appropriate clinical documentation for review and to meet inpatient criteria by the Interqual Guidelines. The Case Managers are responsible for the research and appeal UR denials; micro management of patients to ensure appropriate and timely resource utilization; timely and accurate communication to insurance utilization review for certification of admission and continued stay. This position also coordinates patient care with an interdisciplinary team; screens and coordinates authorization of requests for capitated services for all assigned managed care where the hospital has a financial responsibility; participates in peer review; and is pro-active in reducing avoidable days. Hours vary depending upon assignment. Rotate Saturday/Sunday coverage. This is a non-exempt position.
Current license as a Registered Nurse in California, or related health care professional
Three (3) years Case Management/UM experience in an acute care facility
Knowledge and experience with Medi-Cal - preferred
Good communication skills and ability to work with others
Basic computer skills
Child Abuse Identification
Elder Abuse Identification
California RN License
Internal Number: 2005035982
About John F. Kennedy Memorial Hospital
Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.