About this role
We are currently seeking a highly motivated Pediatric Case Manager. This role will report to the Supervisor – Inpatient Case Management and enable us to continue to scale in the healthcare industry. This is an on-site role where the expectation is to work at Foothill Regional Medical Center. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team Comply with Case Management Department’s policies and procedures 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management Utilize Milliman Care Guidelines, CMS, Title 22 guidelines and criteria for appropriateness of transition of care for members in SNF, SA, ARU, LTAC setting Collaborating with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission Responsible for coordinating the required initial and concurrent reviews based on the review of medical records received and accurate reporting of all admissions to Medical Director and Manager and/ or Supervisor of Case Management Department Review of medical records and/or other documentation to determine medical necessity, appropriateness and level of care utilizing Milliman Care and other appropriate Guidelines Assess, plan, implement, coordinate, monitor, and evaluate all options and services with the goal of reducing hospital readmission Attends/coordinates Case Management meetings on and off-site as necessary Interacts with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements Attend to provider and interdepartmental calls in accordance with exceptional customer service Maintain good relationships with health plans, facilities and medical directors. Resolve problems that arise with any IPA medical directors Report to Manager and/or Supervisor of Case Management on activities and/or problems occurring throughout the day