RN Case Manager
Reputable, family-oriented health plan seeing an RN Case Manager to join their family.
The RN will be responsible for conducting pre and post payment review of inpatient admissions, outpatient services, and other procedures to assess the medical necessity and appropriateness of services on-site or in-house.
Responsibilities include but not limited to:
-Apply all aspects of medical review, including pre-authorization, concurrent review, screening for quality of care issues, and discharge planning.
-Document rationale for medical decisions made.
-Identify at-risk members who would benefit from health management programs through comprehensive health assessments.
-Monitor and evaluate patient's plan of care and identify potential issues through telephonic outreach. Recommend appropriate interventions.
-Promote member and provider satisfaction.
-Provide continuity and consistently of care by building positive relationships between member and family, physicians, provider, care coordinator, and health care plan.
-Participate in department initiatives and projects.
-California RN License
-3-5 years experience in utilization review.
-Associate degree in nursing
-Experience working in managed care/workers compensation
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
-Understanding of health care delivery system access points and services.
-Correct application of healthcare management guidelines.
-Ability to navigate the healthcare delivery system.Company Description
Quality Staffing With Care
All's Well Health Care Services is a privately held, diversified service organization comprised of a cohesive team of innovative people dedicated to providing the highest quality healthcare staffing services with the greatest value. We provide cost effective solutions to all levels of healthcare staffing. We bring recruitment solutions 365 days a year to our healthcare clients through creative, cost effective, quality staffing of nurses, allied health professionals, therapists and healthcare administrative personnel.