Supv - Case Management - SFMC Utilization Review in Lynwood, CA at Prime Healthcare

Date Posted: 6/8/2020

Job Snapshot

Job Description


Responsibilities

The working Supervisor of Case Management is responsible for providing supervision to the Social Worker Case Managers, RN Case Managers, UR Tech, and Discharge Planners; as well as working with the facility Medical Review Coordinator (MRC) on all cases of Peer to Peer review, outcomes and initial appeal requests.  The Case Management Supervisor provides oversight for the quality and resources management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management.  Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a seamless delivery of care.  The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record to assure all parameters for MCG/Milliman criteria/InterQual which includes the medical overview to find medical necessity, intensity of service and severity of illness.

Qualifications

Education and Work Experience
 
1.    Current state Registered Nurse License required.
2.    At least 5 years of progressive supervisory experience in a Healthcare field preferred.
3.    Five years acute care nursing experience preferred.  Current BCLS (AHA) certificate upon hire and maintain current;
4.    Knowledge of Milliman Criteria and InterQual Criteria preferred.
5.    Experience and knowledge in basic to intermediate computer skills.
6.    Behavioral Violence Prevention Training within 3 months of hires and maintain current.
 
 
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf