Active California license required. Minimum 2 years acute care case management experience. Travel experience required (no first-time travelers). Certifications: BLS. Experience with Epic charting system. References: 2 supervisor references from within the past year required.
Coordinate patient care and manage discharge planning. Conduct concurrent and continued stay reviews to ensure medical necessity. Process prior authorizations, appeals, and denials effectively. Maintain compliance with utilization criteria, including InterQual and Milliman. Uphold HIPAA regulations in all patient interactions and care management activities. Manage the plan of care and DME ordering as needed.
Flu vaccine required (no exemptions during flu season). Request time off (max 2 weeks total; no RTO in the first 2 weeks of assignment). Completion of pre-start modules required (12 hours billable + 12 hours non-billable).
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