Dignity Health

  • Case Manager RN

    Job ID
    2018-57386
    Employment Type
    Full Time
    Department
    Case Management
    Hours / Pay Period
    80
    Facility
    Dignity Health Management Services Organization
    Shift
    Day
    Location
    Bakersfield
    State/Province
    CA
    Standard Hours
    Mon-Fri (8-5 PM)
    Work Schedule
    8 Hour
  • Overview

    The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

     

    Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

    Responsibilities

    Conducts medical reviews for necessity, level of care, and benefit reviews rendered in the inpatient and outpatient setting to ensure the patient receives the highest level of care.  Coordinates with providers, provider staff, and hospital staff, patients and patient family members to establish an appropriate level of care.

     

    JOB KNOWLEDGE, SKILLS & ABILITIES

    • Knowledge of nursing processes, care management, and continuity of care.
    • Familiarity with regulatory requirements for managed care, HMOs, and EPOs.
    • Ability to apply criteria to identify appropriate level of care on all admissions and clearly document any research conducted and rationale of decisions made.  Ability to identify care needs across the age continuum and according to principles of growth and development over the life span.
    • Ability to apply appropriate business rules, medical guidelines and/or health plan benefits to authorization decision making.
    • Proficiency with health plan criteria/benefits and regulatory requirements as they relate to patient management across the continuum of care.
    • Proficient with standardized criteria, Interqual/Milliman, MCG, Medicare, etc.
    • Knowledge of network and benefit limitations and ability to collaborate with stakeholders to find alternatives that meet patient needs and achieve positive outcomes.
    • Knowledge of disease management strategies.
    • Basic knowledge of CPT and ICD 9/ICD 10 codes.
    • Ability to interpret and communicate complex contract or benefit language.
    • Willingness to work as part of a team, working collaboratively with others to achieve goals, solve problems, and meet established organizational objectives and management of patients.

    Qualifications

    • Current California RN license required.
    • Five or more years of experience working in a medical facility, hospital, or other healthcare related environment; managed care experience preferred.
    • Two years experienced working with a medical group or IPA preferred.
    • Completion of case management certificate preferred.
    • Valid CA driver’s license
    • Must meet hospital credentialing requirements to obtain facility ID.
    • Bachelor’s degree preferred..
    • Bilingual Spanish/English

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