Medix is looking to hire an Inpatient UM RN/LVN Case Manager in Van Nuys, 91405 with a not-for-profit long-term acute care hospital.

The Case Manager is responsible for reviewing patient admissions and ongoing hospital stays to ensure they are medically necessary and appropriate and obtain Insurance authorization. This role involves assessing patient records, coordinating with healthcare providers, and adhering to regulatory guidelines to secure authorization from insurance for continued inpatient care.

Responsibilities:

• 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 the EMR system every shift.

Requirements / Experience:

• Active CA Registered Nurse or LVN license required (BSN preferred)
• Acute clinical experience

• Experienced in Inpatient case management, UR/UM

• Possesses knowledge of applicable regulatory standards and is able to perform audits based upon these standards
• Thorough knowledge of UR concepts
• Computer literate
• Excellent verbal and written communication skills

Schedule:

• Monday- Friday 8:00 -5:00 pm
• Open to 4/10s

Pay range:

• RN: $55 - $62/hour
• LVN: $30 - $45/hour

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