Senior Services Case Manager --- RN

Are you looking for a company that you can rely on? At Prospect Medical we understand how important it is to be taken care of. With 20 years in the business and now managing 13 IPA’s, we offer stability and reliability.

Prospect Medical is Southern California’s 3rd largest IPA---and growing! Come join our team of dedicated professionals committed to providing quality service and quality care to our 1,000+ primary care and 70,000+ specialist physicians and to our 240,000+ members.

Prospect recognizes that you have unique goals, dreams and ambition. That’s why we go out of our way to understand and share your vision.

 Prospect is looking for an ideal candidate to fill the

Senior Services Case Manager - RN position:



SUMMARY


Responsible for obtaining reviews on all senior hospitalized members and concurrent review in hospital or skilled nursing facility.  Focus on cost effective, appropriate healthcare.

 


ESSENTIAL DUTIES AND RESPONSIBILITIES

 

The following are included but not limited to:

·  Check all voice mail at least every 2 hours and respond to messages within 24 hours.

·  Check daily census each morning and update as needed for both acute hospital and skilled facility.

·  Daily update and documentation of admission/concurrent and discharge dates of all inpatient cases.

·  Update specialist information in IDX system as indicated.

·  Inform facility and provider when patient is not eligible or terminated.

·  Assist with referrals for senior case managed members.

·  Special projects assigned by Manager/Director or Medical Director.

·  Coordinates and facilitates all transfers as indicated.

·  Clearly documents all inpatient notes in a timely manner within 48 hours.  Discharges to be closed in system within 24 hours.

·  Review daily with Medical Director and Intensivists.

·  Refer any high acuity, complicated case to appropriate case manager and health plan.

·  Maintain health assessment and disease management as required by health plan.

 

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

 

EDUCATION and/or EXPERIENCE 



·  RN license. 

·  Experience in Senior Service department, Medicare and CMS guidelines.

· Previous experience in HMO medical group/health plan Case Management department.

Prospect Medical has a solid past and a dynamic future.  Nearly 20 years old, we have grown and matured---we are now publicly-traded (AMEX:PZZ), IPA and medical management services company.  We contract with all major regional HMO’s including PacifiCare, Blue Cross, Health Net and CIGNA.  We are now serving California’s seniors with a superior Medicare program, and we are pursuing additional growth through a strategy of targeted acquisition.  We succeed through the use of superior technology, proven management procedures, and committed employees. Our success allows us to offer excellent compensation and one of the best benefit packages in the industry.

If you are a qualified, high-achieving professional who wants to make a positive difference in the world of managed care, please submit your resume online.

Quality Service, Quality Care…that’s who we are!

Looking for a great company who cares, then you should call Prospect today!

Please visit our website for more information and a listing of all our open positions

www.prospectmedicalholdings.com