The Case Manager establishes effective working relationships with all constituencies including patients and their families, physicians, staff, insurance contacts and other healthcare providers. Under the direction of the Manager of Case Management, the Case Manager coordinates the care of a patient with insurance, doctor, state agencies, home health, other facilities, etc., to facilitate a safe discharge/transition to the next appropriate level of care. The Case Manager maintains compliance with Arizona professional nursing standards, Joint Commission, insurance regulations and all Federal and State standards of care.
Current Arizona RN (Registered Nurse) license, CCM preferred
Two to five years’ experience in Case Management, hospital setting preferred
Knowledge of The Joint Commission regulations and Medicare, Commercial insurance and AHCCCS standards and requirements
Clinical experience preferred
Competent application of InterQual criteria, knowledge of Milliman criteria optional
Possess the ability to handle multiple projects simultaneously and to make independent decisions
Effective verbal and written communication skills with staff members, patients and their families and other healthcare providers.
Proficient computer skills (Microsoft Office Products & Outlook)
Experience using healthcare software systems
Supervises: No direct reports
Contracts/Interacts with: Physicians, all hospital staff, patients and families, insurance companies other healthcare facilities and home health and DME.
Career Path: Suggested promotion to : Manager of Case Management
Equal Opportunity Employer/Veterans/Disabled
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