At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. MemorialCare stands for excellence in Healthcare. Across our family of medical centers and physician groups, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.
Essential Job Outcomes * Perform daily or as clinically indicated on-site clinical, telephonic or faxed reviews for patients in the acute and SNF inpatient setting according to published workflow and productivity standards * Evaluate and monitor patients for inappropriate admissions, appropriate level of care and length of stay Apply MCG, goal length of stay or other applicable evidence based guidelines (i.e.: InterQual). Assist in maintaining hospital bed days within goals set by MCMF UM/CM program * Document readmission, issue variances or denials when applicable. Issue Important Message from Medicare and Detailed Notice of Discharge per regulatory guidelines if notified of an appeal * Work collaboratively with Hospital Case Managers, Discharge Planners and health plans. Provide Hospital staff with contracted providers per health plan contracts * Meet with patient and/or family at bedside as needed. Make follow up appointments with PCP and Discharge Clinic * Evaluate and supervise a discharge plan for each member assigned. Process discharge orders per criteria, benefits and eligibility * Determine patient level of acuity and refer to Discharge Clinic, Complex Case Management and Disease Management as indicated * Participate in daily inpatient rounds, huddles, team meetings webinars, training and any other meetings as directed by leadership team. * Repatriate patients whenever possible if admitted to out of network facilities. Assist health plan repatriate out-of-area patients by providing Hospital Bed Board and Hospitalist phone numbers. Ensure that patients are followed by assigned/contracted Hospitalist and contracted Specialists * Submit letter of agreement for non-contracted physicians to contracting department when indicated * Understand DOFR’s (division of financial responsibility) as it relates to the inpatient process * Other duties as assigned
Experience * Work experience in Microsoft Word, Microsoft Excel and Microsoft Outlook. * Work experience applying evidence-based criteria (i.e.: MCG, lnterqual); Health plan medical policy / clinical coverage guidelines.
Preferred: * Previous inpatient Case Management experience * Previous and or ability to learn use of electronic medical record, UM/CM platforms or electronic health record preferred.
MemorialCare Medical Group is a physician-based organization established to provide advanced comprehensive, effective and efficient health care. With over 30 locations from Long Beach to Dana Point, MemorialCare Medical Group includes more than 250 physicians in the areas of internal medicine, family medicine, pediatrics, geriatric medicine, cardiology, cardio thoracic surgery, gastroenterology, neurology, pulmonology, psychiatry, psychology, rheumatology, sleep medicine and therapeutic acupuncture.In addition to multiple locations throughout Orange County, MemorialCare Medical Group offers Urgent Care Centers that are open 365 days-a-year, Telephone Advice Nurses available 24 hours-a-day, 7 days-a-week; and lab and digital X-ray services available on-site at most locations.