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  • 작성자choiceone
  • 날짜2024.04.18
  • 조회수28

제목케이스매니저 구합니다. RN/LVN Nurse Case Manager

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지역정보 BUENA PARK / CA
회사명 PremierOne Plus MSO
업종 기타

Description

• Responsible for utilization management,
utilization review, or concurrent review (telephonic inpatient care
management)


• Perform reviews of current inpatient
services and determine medical appropriateness of inpatient and outpatient
services following evaluation of medical guidelines (MCG) and benefit
determination


• Perform medical necessity and level of care
reviews for requested medical services and refer to Medical Directors for
review as appropriate depending on case development


Responsibilities and Duties


• Performing care management activities to
ensure that patients move through the continuum of care efficiently and
safely


• Assesses and interprets customer needs and requirements


• Reviewing cases and analyzing clinical
information in conjunction with Medical Directors to determine the
appropriateness of hospitalization
• Performing Nurse to Physician interaction to
acquire additional clinical information or discuss alternatives to current
treatment plan


• Escalating cases to the Medical Director for
case discussion or peer-to-peer intervention as appropriate


• Performing anticipatory discharge planning
in accordance with the patient's benefits and available alternative
resources


• Referring patients to disease management or case management programs


• Assisting with the development of treatment plans


• Documenting activities according to established standards

• Identifies solutions to non-standard requests and problems

• Solves moderately complex problems and / or
conducts moderately complex analyses



• Works with minimal guidance; seeks guidance on only the most complex tasks


• Provides explanations and information to others on difficult issues

• Acts as a resource for others with less experience


• Works with less structured, more complex issues


• Update and review the case management and
utilization management policies and procedures as needed


• Oversee the outpatient UM department


• Work on health plan initiated audits related
to case management, utilization management, and related audits


• Submit and implement corrective action plans
for issues identified during health plan audits


Qualifications and Skills


Basic Qualifications
• Current and unrestricted RN or LVN License in the State of California

• Clinical experience in an inpatient / acute setting


• Problem solving skills; the ability to systematically
analyze problems, draw relevant conclusions and devise appropriate courses
of action


• Excellent verbal and written communication
skills; ability to speak clearly and concisely, conveying complex or
technical information in a manner that others can understand, as well as
ability to understand and interpret
complex information from others


• Intermediate computer skills - Proficiency
with Microsoft Word, Outlook and Internet Explorer, with the ability to
navigate a Windows environment




Preferred Qualifications


• 1 year Utilization Management Inpatient experience

• Utilization Review experience

• Knowledge of or experience with Milliman Care Guidelines

• Experience in discharge planning or chart review

• Experience in acute long term care, acute
rehabilitation, or skilled nursing facilities
• A background that involves utilization
review for an insurance company or in a managed care environment

Resume submission :
info330amm@gmail.com

* DISCLAIMER
이곳에 게시된 글들은 에이전트 혹은 사용자가 자유롭게 올린 게시물입니다. 커뮤니티 내용을 확인하고 참여에 따른 법적, 경제적, 기타 문제의 책임은 본인에게 있습니다. 케이타운 1번가는 해당 컨텐츠에 대해 어떠한 의견이나 대표성을 가지지 않으며, 커뮤니티 서비스에 게재된 정보에 의해 입은 손해나 피해에 대하여 어떠한 책임도 지지 않습니다.

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