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The RN Case Manager provides discharge planning by collaboratively determining level of care needs beyond acute care, providing decision support to patients and families and physicians, managing patient and family expectations and ensuring a smooth transition to the next level of care and services.
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Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.
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Utilization Management Conducts medical necessity review for appropriate utilization of services from admission through discharge. Discharge PlanningConducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning.
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Discharge PlanningUnder appropriate supervision, conducts comprehensive, ongoing assessment of patients and family to provide timely and safe discharge planning. QualificationsEducation: Graduate of an accredited program required: LPN or RN Master of Social Work with licensure as required by state regulations; OR Bachelor of Social Work with licensure as required by state regulationsLicenses/Certification:Healthcare professional licensure required as Registered Nurse, LPN or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.
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Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families.
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Provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.
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Successful completion of Pediatric Advanced Life Support (PALS) course is required when pediatric care is included in the facility scope services within 90 days of employment or documentation of current PALS certification.
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The Licensed Practical Vocational Nurse / LPN / LVN identifies and addresses psychosocial needs of patients and family; communicates with Social Services/Discharge Planner regarding both in-hospital and post discharge needs.
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This position will further support the department needs for Release of Information, discharge coordination or other duties as assigned. Qualifications/Experience: Minimum one (1) year of denials management experience in acute care setting highly preferred.
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License, Certification, Registration Registered Nurse License (California) Basic Life Support Additional Requirements: Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of utilization review/management, care coordination, transfer coordination, discharge planning or case management.
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Provides direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care. Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting to also include supervisory or management experience.
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Manages relationships with payor and referral sources, the facilitation and coordination of the discharge planning process and serves as the patient and family advocate. Appropriate certification in Case Management preferred; for example, Commission for Case Manager Certification (CCMC); Association of Rehabilitation Nurses (ARN) certification.
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Under the direct supervision of the Program Manager and consultative supervision of the Occupational Therapy Practice Manager, this Occupational Therapist is responsible for providing quality care for patients receiving occupational therapy services, including evaluation, assessment, treatment planning, goal setting, treatment implementation, discharge planning to transition the patient toward maximum independence.
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Qualifications: Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting to also include supervisory or management experience. Registered Nurse License (California) Additional Requirements: Demonstrated knowledge of operations and healthcare management; TJC, Title XXII, Medicare, MediCal and other local, state and federal regulations.
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This position is responsible for utilization review, assessment of discharge planning needs and coordination of effective discharge plan. Job Title: Utilization Review Registered Nurse- Behavioral Health Unit/FT/Days Job Summary:This Utilization Review (UR) Registered Nurse (RN) position supports the Mission of Pipeline Health through the provision of distinctive and compassionate care to our patients.
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