Travel Nurse RN - Case Manager - $59 to $64 per hour in San Pedro, CA - Legacy Personnel : Job Details

Years of Experience: 2 year(s)

Note: 2-year acute medical Care Manager experience performing both roles of Care Coordination and Utilization Review and discharge planning, Interqual and Epic are all HARDSTOPS

Travel Experience Required: YesNote: seasoned traveler required, can screen 1st time traveler

Work Settings : Acute Hospital

Case Management/Utilization Review

Admission CriteriaBenefits EligibilityCare coordinationConcurrent ReviewContinued Stay ReviewsDetermine Medical Necessity per Evidence-Based GuidelinesDisability case managementDischarge PlanningDisease managementNeeds Assessment/ Order DMEPlan of CarePre-Cert Review*Prior AuthorizationsRetrospective Review*Utilize InterQual CriteriaWorker's comp case management*

Utilization Review

Admission CriteriaConcurrent ReviewContinued Stay ReviewsMedical NecessityPrior AuthorizationRetrospective Review*Utilize InterQual Criteria

Regulatory

CMS: Centers for Medicare and Medicaid ServicesCPT (Current Procedural Terminology) coding and billing*Department of HealthDRG (Diagnosis Related Groups)HEDIS (The Healthcare Effectiveness Data and Information Set) Measures*HIPAA (The Health Insurance Portability and Accountability Act)ICD 10 Coding*NCQA (National Committee for Quality Assurance)*OSHA: Occupational Safety and Health Administration*The Joint Commission/ Core Measure/National Safety GoalsWorker's Compensation

Acute Hospital Experience by Specialty

ERICUMS

Additional Skills

CA experience in Case Management