We are actively seeking an Inpatient Care Manager who is responsible for Utilization Management, Utilization Review, or Concurrent Review and discharge planning (on-site or telephonic inpatient care management) in hospitals in the Yakima or Vancouver, Washington area.

 *** Must reside in the state of Washington. This is a work from home and on site at hospitals position***

Primary responsibilities include:

• Performing utilization and concurrent review of inpatient cases using Milliman and/or InterQual criteria
•   Conducting clinical chart assessments
• Discussing cases with treating physicians and other healthcare professionals to better understand plans-of-care
• Participating in rounds with the Medical Director and discussing cases as needed
• Determining need, if any, for intervention, and discussing with Case Managers and physicians
• Identifying and evaluating delays in care
•   Initiating a discharge planning and readmission prevention plan
• Approving bed days for inpatient cases (when applicable)
• Arranging alternative care services; Contacting and maintaining communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum
• Gathering clinical information to assess and expedite care needs
•   Facilitating timely and appropriate care and effective discharge planning
• Participating in team meetings, education discussions and related activities
• Maintaining appropriate documentation
• Consulting with the Medical Director as needed to troubleshoot difficult or complex cases
• Identifying opportunities for improved communication or processes
• Participating in telephonic and in-person staff meetings

Qualifications

•   Current, unrestricted RN license for the state of Washington is required
•   Minimum of 5 years total experience including clinical experience in an inpatient/acute setting
• Experience in discharge planning and/or chart review desired
• Background that involves utilization review for an insurance company or in a managed care environment would be preferred
• Familiarity with Milliman criteria guidelines and/or Interqual would be helpful
• Case management certification and/or experience is preferred
• Solid computer skills
• Ability to build and maintain relationships will be essential
• Managerial background is a plus
• Bachelor's degree is ideal  

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