Insurance Case Manager Jobs in Banning, CA (NOW HIRING)

Job type: Full Time

Shift: Days

Hours: 0800-1630

Schedule: 10 shifts per two week pay period. Rotating weekends required.

SUMMARY:

The individual in this position is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to self-determination. The individual in this position has overall responsibility to assess the patient for transition needs including identifying and assessing patients at risk for readmission. Conducts complex psycho-social assessment and interventions to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including:

• Utilization Management supporting medical necessity and denial prevention
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating efficient throughput while assuring care is sequenced and provided at the appropriate level of care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Education provided to physicians, patients, families and caregivers
• Provides educational programs for Case Management Department on community resource use in discharge planning
• Provides reports to Director of Case Management and hospital leadership as requested
• Provides management of the department, but not limited to, hiring/training/managing staff, schedule coordination, analysis and reporting, interfacing, collaborating and working closely with the other departments

This individual's responsibility will include the following activities: a) complex psycho-social transition planning assessment and reassessment and intervention, b) assistance with adoptions, abuse and neglect cases, including assessment, intervention and referral as appropriate to local, state and /or federal agencies, c) care coordination, d) implementation or oversight of implementation of the transition plan, e) leading and/or facilitating multi-disciplinary patient care conferences including Complex Case Review, f) making appropriate referrals to other departments, g ) communicating with patients and families about the plan of care, h) collaborating with physicians, office staff and ancillary departments,i) assuring patient education is completed to support post-acute needs , j) timely, complete and concise documentation in Tenet Case Management documentation system, k ) maintenance of accurate patient demographic and insurance information, l) and other duties as assigned.

Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At Hi-Desert Medical Center hospital, were seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.

At Hi-Desert Medical Center, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status

Desert Care Network serves the healthcare needs of the Coachella Valley and Morongo Basin regions in Southern California with three hospitals Desert Regional Medical Center in Palm Springs, JFK Memorial Hospital in Indio and Hi-Desert Medical Center in Joshua Tree. The hospital network provides advanced care with services such as comprehensive stroke care, a cancer center, a Level 1 Trauma Center and the only Level 3 Neonatal Intensive Care Unit (NICU) in the Coachella Valley. Desert Care Network is committed to healthcare equality. Join our team!

Required qualifications include Master in Social Work (MSW)

Accredited Case Manager (ACM) preferred.

Minimum of two years acute hospital experience preferred.

Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills and computer literacy.

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