ED Access Case Manager, Care Management, Per diem, 7pm-7:30am

The RN Access Case Manager provides care coordination which emphasizes positive partnerships with nursing, physicians, and other key disciplines in order to coordinate admissions, transfers, and repatriation to PHDH through the emergency room or direct admission. The RN Access Case Manager works closely with insurance and various payers to coordinate and assist with reparation / transfer of out-of-network patients from PHWH to the patient’s contracted facilities. The RN Access Case Manager performs utilization review with a high level of expertise by using criteria that demonstrates medical necessity to achieve authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, Outpatient). The RN Access Case Manager also provides oversight of the hospital bed control system and works in collaboration with the House Supervisor to ensure appropriate placement of patients to the right level of care. The RN Access Case Manager works to ensure appropriate utilization of hospital resources in all settings and levels of care.PIH Health is a nonprofit, regional healthcare network that serves approximately#J-18808-Ljbffr