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1 2nd April 11:27
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Default US-NJ-HACKENSACK - Onsite Inpatient Case Manager - Hackensack, NJ, Sp (GO Jobs)

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Onsite Inpatient Case Manager - Hackensack, NJ, Sp

Salary: $0 - 0 / Not Specified
Job Type: Full Time
Category: Health Care

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Spanish or Portuguese BILINGUAL - Job Functions: Nursing - Case
Management, Nursing - LPN, Nursing - Patient Service Tech,
Nursing - Staff RN - Duties and Responsibilities: Based from
your home office travel daily to: Hackensack Hospital in
Hackensack, NJ Provide through an on-site process, a concurrent
and/or retrospective utilization and case management approach in
the assessment and management of all members admitted to their
assigned inpatient facility/ facilities. Utilizes CIGNA approved
guidelines and tools to rigorously assess the clinical status of
the member, the level of care and the services the member is
receiving as clinically appropriate covered services. Anticipates
care needs along the continuum of inpatient services and
facilitates coordination across the network with providers,
participants and caregivers to assure timely discharge or
transfer to an alternate Level of Care. Consults with their
assigned Managers & Physician Directors to resolve any issues in
delay of services, or barriers to discharge in a timely manner.
• Develops and defines a structured working relationship with key
partners in assigned inpatient facilities to support regular,
effective, communication and live exchange of information in
compliance with all Federal/State/Facility Contract and internal
CIGNA requirements. • Retrieves active Daily census each
morning and prioritizes cases for review • Accesses the
approved CIGNA guidelines for each inpatient review, and directs
the communication with the facility to elicit clinical
information as required in the guidelines. Limits the retrieval
of protected health information to that which is required by the
guideline or necessary to discharge planning. • Identifies all
cases appropriate for further medical management intervention,
initiates and discusses options for discharge planning with the
facility, provider, vendor, member and/or family on the day of
identification, implements plans as appropriate and do***ents all
successful interactions in the case management section of the
medical mgmt system for tracking of case management activities
and outcomes related to those actions Provides post discharge
outreach calls on those members who have successfully discharged
as part of the inpatient case management/and discharge planning *
Reviews level of care on all inpatient admissions and validates
approved level of care according to the member's clinical status,
with the facility to assure consistency of approved level with
the level of care the facility will use for billing. • Applies
knowledge of medical management and Personal Health Solutions as
demonstrated through a proactive focus on discharge planning, and
identification of any obstacles to discharge with every review.
• Do***ents all clinical information, discharge plans, level of
care changes. Validates any change in level of care consistent
with contract and state requirements. • Identifies new
referrals for complex or catastrophic case management and
coordinates ongoing continued stay review process with the Case
Manager to assure a timely discharge. • Identify and elevate
potential quality of care issues to Quality for follow-up. •
Take actions necessary to prevent and/or reduce overuse, misuse
and underuse and reduce variat

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See Job Description

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Onsite Inpatient Case Manager - Hackensack, NJ, Sp

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Contact Information
Reference Num: 118485 (include when applying)

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