Los Robles Hospital & Medical Center is a licensed 404 bed acute care facility. Fully accredited by the Joint Commission, Los Robles Hospital has the only Level II Trauma Center in Eastern Ventura County and the only Emergency Room in both Los Angeles and Ventura counties coveted EDAP (Emergency Department Approved for Pediatrics) rating. In addition, it is the only hospital certified by both counties as a STEMI designated heart attack center for rapid heart attack response and is a certified Primary Stroke Center. With over 600 physicians on its medical staff, representing over 50 medical specialties, Los Robles is proud to be the community's most trusted resource for health and a regional destination for care.
Primary responsibility is coordination of the Case Management Point of Entry , to ensure proper statusing of all outpatient elective procedures, as well as Authentication of Medicare Order Forms (MOF), Observation status patients, Case Manager for the PACU and CVOU areas for discharge planning, and covering the ER when there is not a case manager assigned to that unit. Responsible for monitoring observation hours for all payers but particularly for the Medicare patients, not to exceed more than 1 midnight in observation status. Presents data on the daily observation call with the Divisional Case Management Director and Denial Director. Presents data, graphics, and reports to committees, including the Utilization Management Committee. Provides direct input and recommendations for Program improvement, Policy development or Procedural changes, which enhance the decrease in Denials. Recognized as a subject matter expert for nursing, physicians, and ancillary departments. Exemplifies integrity and professionalism; is self directed and holds confidential all aspects of patient information.
REQUIRED KNOWLEDGE, ABILITIES AND LICENSING:
Current Registered Nurse in the State of California
Bachelor's degree in Healthcare Preferred, or 5 plus years of work experience in Case Management, inpatient acute as well as outpatient settings. Managerial experience is preferred. Experience with Insurance companies and Emergency Room experience is preferred. ACM and/ or CCM certifications are preferred.
Current American Heart Association Healthcare Provider or American Red Cross Professional Rescuer CPR Card is preferred.
Must complete initial and annual competencies; general and nursing orientation,
Experience with Meditech required. Expert knowledge of Midas, Interqual/ CERME, Conditions of Participation as pertaining to the Medicare 2 Midnight ruling, Addendum E, and discharge planning required. Knowledge with data analysis, trending and reporting is preferred.
The ability to retrieve information from an electronic database(s) and communicate findings to all stakeholders in an organized method is required. Presentation of data to CFO, Medical Staff and Case Management Staff must be in a clear, concise manner.
Must demonstrate enthusiasm and a willingness to learn.
Experienced with physician relationships; and dealing with health care professionals.
Exhibits time and resource management abilities. Manages multiple moving deadlines with frequent interruptions, and shifting priorities.
Expert project management skills; ability to work independently, be flexible, and lead a strong inter disciplinary team.
Excellent communication skills; oral and written; excellent critical thinking, judgment and problem solving skills.
Commitment to ongoing education in the Case Management continuum.
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