Registered Nurse Case Manager (RN)
About The Position
The Registered Nurse Case Manager position involves a variety of tasks including integrated concurrent review for utilization, quality, and risk, as well as discharge planning and case referrals for patients. The role requires working with medical and professional staff to obtain appropriate clinical documentation for review and to ensure patients meet inpatient criteria according to Internal Guidelines. Case Managers are also responsible for researching and appealing utilization review (UR) denials, micro-managing patients to ensure appropriate and timely resource utilization, and maintaining timely and accurate communication with insurance utilization review for certification of admission and continued stay.
Requirements
- Current license as a Registered Nurse in California, or related health care professional
- Three (3) years Case Management/UM experience in an acute care facility
- CPR certification
- Good communication skills and ability to work with others
- Basic computer skills
Nice To Haves
- Knowledge and experience with Medi-Cal
Responsibilities
- Perform integrated concurrent review for utilization, quality, and risk
- Conduct discharge planning
- Handle case referrals for patients
- Work with medical and professional staffs to obtain appropriate clinical documentation for review
- Meet inpatient criteria by the Internal Guidelines
- Research and appeal UR denials
- Micro manage patients to ensure appropriate and timely resource utilization
- Ensure timely and accurate communication to insurance utilization review for certification of admission and continued stay
Benefits
- Up to $25,000.00 Sign on Bonus for Qualified Candidate
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
1,001-5,000 employees
