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Inpatient Case Manager- Laguna Hills, CA

UnitedHealth Group


Location:
Laguna Hills, CA
Date:
04/27/2017
Job Code:
1723129
Apply on the Company Site
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Job Details


Inpatient Case Manager- Laguna Hills, CA(Job Number:703531)
Description

At Monarch HealthCare, an OptumCare Company, you will perform within an innovative culture focusing on transformational change in the health care system. You will leverage your skills across a diverse and multi - faceted business. Your contributions will have an impact greater than you have ever imagined! Join us and help people live healthier lives while doing your life's best work.(sm)
 
As a part of our continued growth, we are searching for a Inpatient Case Manager to join our team
 
***This position is an On - Site Case Manager with office at Saddleback Memorial Hospital***
 
Monday - Friday 8:00 AM - 5:00 PM
 
Primary Responsibilities:  
  • Performs concurrent and retrospective onsite or telephonic clinical review at the designated network or out - of - network facilities as needed / directed by the ICPS Management team
  • Documenting medical necessity and appropriate level of care utilizing clinical guidelines (e.g. Milliman, Interqual). Complies with CMS regulations and Health Plan requirements
  • Interacts and effectively communicates with members, their families and / or designated member representative to assess discharge needs and formulate discharge plan, provide Health Plan benefit information, and services available based on clinical need
  • Efficiently navigates and utilizes computer data entry programs including, but not limited to: Microsoft Office (Outlook, Word, and Excel)
  • Provides guidance and benefits information for members and their families and facility discharge planners
  • Documents and maintains a Continuity Plan of Care for the Monarch HealthCare member by assessing and identifying continued needs upon discharge to encompass; health services, durable medical equipment, hospice, follow - up physician appointments, skilled versus sub - acute versus custodial levels of care
  • Issues the appropriate denial letters based on Health Plan or CMS guidelines utilizing ICE language

Job Clinical Utilization Managemen
Primary Location US-CA-Laguna Hills
Other Location US-CA-Irvine
Organization Monarch
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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