The Case Manager is responsible for assessment and review of all admissions and concurrent review for continued hospitalization.  The Case Manager reviews the medical record of patients to document severity of illness (SI) and intensity of service (IS) according to Interqual and CHS criteria that justify the admission and continued hospitalization of patients at Watsonville Community Hospital.  The Case Manager will provide timely utilization reviews as requested by third party payers.  The Case Manager works closely with the Physicians Advisor (PA) and refers all cases that do not meet acute level of care, any delays in service or treatment or long length of stays for review and action.  The Case Manager is responsible for discharge assessments for prime care, IICN and CCU patients.  The Case Manager works with a multidiscipline team including the physician to assist patients and families transition from the acute care level of care to a lower level of care.  This discharge plan may include home health, SNF, board and care facility, custodial care and/or other community resources.  The Case Manager will assess for resources management.  The Case Manager will refer any quality issues to quality management and the Physician Advisor as issues are identified.  The Case Manager will screen for social service intervention in the regular process of reviewing medical charts and make referral to the social worker.  The Case Manager will work closely with the business office, medical records and registration to expedite insurance verification, authorization and payment. Education:  As determined by California Board of Registered Nurses. Experience: Inpatient and/or outpatient case management experience within the last year required.                                                                              Discharge planning experience required.                                                                                                                                                                        Quality review of patient care and retroactive review of patient records.                                                                                                                  Resource management experience desirable Licenses and/or Certifications: California Registered Nurse license.  American Heart Association Healthcare Provider CPR required.

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