Utilization Management Case Manager - Santa Barbara, CA, United States
2 days ago
Job summary
The Utilization Management Case Manager is responsible for the utilization management, quality assurance and discharge planning activities for assigned services/areas/patients within Cottage Health. This role will result in quality outcomes, optimal care/cost management of services and/or procedures.
Responsibilities
- Resource Management: Understand the principles of reimbursement and the services within the reimbursement parameters
- Discharge Planning: On admission initiate coordination of discharge plan with healthcare team patient family stakeholders identifies likely post-discharge needs.
- Quality Assurance Participate improvement organizational performance through quality assurance performance improvement activities participate tools measurement continuous improvement case management functions support system-wide development analysis implementation process initiatives report suspected emerging patterns trends participate denial/appeal process as appropriate cooperate fully risk management activities investigations
- Education As appropriate educate patient/family to care delivery provision service healthcare providers resources issues funding areas choice accountability explain plan treatments context patient values language understood by patient/family assist coordinating educational plan interdisciplinary healthcare team Leadership Collaboration Provide consultation support ongoing education promote manage value-oriented experience persons served serve consultant case management issues coach/mentor others participate care planning activities rounds committee meetings other activities appropriately demonstrate continuing effort improve job performance better organization like continuing education/professional development participation/membership professional organizations
Job description
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