Medix is currently hiring for an Inpatient Nurse Case Manager at a hospital that is a national leader in weaning chronically critically ill patients from mechanical ventilation. Either a Registered Nurse (RN) or Licensed Vocational Nurse (LVN), is responsible for reviewing patient admissions and ongoing hospital stays to ensure they are medically necessary and appropriate and obtain Insurance authorization. This position is fully onsite at the hospital.

Schedule - Monday - Friday 8a-5p or 4 10's

Job Summary

This role involves assessing patient records, coordinating with healthcare providers, and adhering to regulatory guidelines to secure authorization from insurance for continued inpatient care at the Hospital. The nurse must evaluate the clinical information against established criteria and communicate effectively with third-party payers to obtain necessary insurance approvals. They will seek guidance from physicians and the utilization management team to ensure optimal patient outcomes. Prior experience in obtaining ongoing authorization is required, along with strong clinical judgment, excellent communication skills, and knowledge of healthcare regulations.

Responsiblities

• Partners with medical staff, utilizes scientific evidence for best practices, relevant data and compliance with the mission/philosophy, standards, goals and core values.
• Participates in the development of patient focused long/short term goals, implementing, evaluating and modifying the care plan.
• Collects and reports utilization data and quality information, such as delays in service, possible avoidable days, provider preventable conditions, readmissions, and length of stays, etc.
• Assists in preparing UM/QI case issues, gathering requested records/responses.
• Consults with the nursing staff working directly with clients in the nursing care areas. Provides instruction to hospitalized members and their families; and serves as liaison between the member, the physician, the hospital and the Plan.
• Case Manager completes appropriate, accurate and timely, documentation into EMR system every shift

Requirements

• Active CA Registered Nurse or LVN license required
• Acute clinical experience
• Experienced in case management, UR/UM
• Possesses knowledge of applicable regulatory standards and is able to perform audits based upon these standards
• Solid experience dealing with UR concepts
• Computer literate
• Excellent verbal and written communication skills

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance