Description:The RN Case Manager is responsible to conduct medical necessity screening and work collaboratively with the interdisciplinary team to provide care coordination for patients.This position complies with the scope of services defined by the Registered Nurse RN state licensure requirements.
Utilization Management: Assures the patient is in the appropriate status and level of care based on Medical Necessity process and submits for Secondary Physician review per Kaiser policy.
Ensures timely communication of clinical data to various payers to support admission, level of care, length of stay and authorization for post-acute services. Advocates for the patient and hospital with payers to secure appropriate payment for services rendered.
Completion of clinical reviews.
Promotes prudent utilization of all resources (fiscal, human, environmental, equipment and services) by evaluating resources available to the patient and balancing cost and quality to assure optimal clinical and financial outcomes.
Identifies and documents Avoidable Days using the data to address opportunities for improvement. Prevents denials and disputes by communicating with payers and documenting relevant information. Coordinates clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) supported by evidence-based practice, internal and external requirements.
Identifying appropriate level of care needs. Assisting with patient transition to the appropriate level of care.
Order clarification admission status and patient classification.
Skills:case management, acute care, registered nurse, utilization management, Care management, Health care, Medical, Insurance verification, Customer service, Rn licenseAdditional Skills & Qualifications:Registered Nurse - RN NEED ACUTE EXPERIENCEED Experience & Epic ExperienceAbout Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
Hiring diverse talent
Maintaining an inclusive environment through persistent self-reflection
Building a culture of care, engagement, and recognition with clear outcomes
Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email [email protected] (%[email protected]) for other accommodation options.