Access Case Manager

Pioneers Memorial Healthcare District Brawley , CA 92227

Posted 11 months ago

The Access Case Coordinator evaluates the medical necessity for admission, and appropriateness of patient care unit placement for all scheduled admissions, direct admits, transfers, and outpatient conversions and provides consultation to physicians prior to patient placement. The Access Case Coordinator will coordinate any unexpected discharge planning needs for this patient population that are not transitioned to the inpatient case coordinator, so that a smooth transition from the acute outpatient care setting to the community setting is ensured and readmission is averted.

Refers to Social Work those patients with complex psychosocial or discharge planning needs and follows-up to ensure appropriate intervention. Acts as a resource to ensure appropriate reimbursement for all scheduled procedures. Dialogues with the payers as necessary to guarantee appropriate reimbursement for outpatients and scheduled admissions.

Communicates with physicians and other members of the interdisciplinary healthcare team to ensure implementation of clinical practice guidelines or standing orders to meet expected standards of care for patients. Provides support and information to patients/families with identified financial or psychosocial needs. Serves as the liaison for the other members of the interdisciplinary team to ensure appropriate and expedient referrals upon decision to admit to the acute care inpatient setting Requirements California RN License, with Bachelor or Masters preferred. 5 years of clinical experience as a Registered Nurse, experience in Case Management preferred Utilization review of discharge planning experience preferred.

Emergency or ICU department experience preferred.

Excellent communications skills that include: Oral comprehension, oral expression, written comprehension, and written expression.



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Access Case Manager

Pioneers Memorial Healthcare District