Registered Nurse Case Manager (RN)
About The Position
The scope of duties encompasses a variety of tasks related to performing integrated concurrent review for utilization, quality and risk, discharge planning, and case referrals for patients. This position works with medical and professional staffs to obtain appropriate clinical documentation for review and to meet inpatient criteria by the Interqual Guidelines. The Case Managers are responsible for the research and appeal UR denials, micro management of patients to ensure appropriate and timely resource utilization, and timely and accurate communication to 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
- Good communication skills and ability to work with others
- Basic computer skills
Nice To Haves
- Knowledge and experience with Medi-Cal
Responsibilities
- Performing integrated concurrent review for utilization, quality, and risk.
- Discharge planning.
- Case referrals for patients.
- Working with medical and professional staffs to obtain appropriate clinical documentation for review and to meet inpatient criteria by the Interqual Guidelines.
- Researching and appealing UR denials.
- Micro managing patients to ensure appropriate and timely resource utilization.
- Timely and accurate communication to insurance utilization review for certification of admission and continued stay.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
1,001-5,000 employees
