Case Management

Opportunity:

RN - Case Management

Job Details:

• Monday through Friday schedule with no weekends and no on-call requirements
• Minimum 2 years of nursing experience required
• Must have acute care case management experience in California (Kaiser experience excluded)
• Outpatient case management, home health, or health plan case management experience will not be accepted as qualifying experience
• Valid California RN license required
• Apply broad knowledge of healthcare delivery and case management within a managed care environment
• Perform comprehensive utilization review, determine levels of care, and manage observation status
• Knowledge of healthcare reimbursement systems including HMO, PPO, PPS, CMS, and value-based reimbursement models preferred
• Working knowledge of laws and regulations affecting case management including CMS, Title 22, CHA Consent Manual, CDPH, and TJC
• Manage post-acute levels of care and associated regulatory compliance requirements
• General understanding of coding and DRG assignment process preferred
• Communicate effectively and promote collaboration between patients, families, physicians, nurses, and ancillary partners
• Work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families
• Strong verbal and written communication and negotiation skills required
• Excellent time management skills required to manage high-volume environment with rapidly changing priorities
• Intermediate computer and technology skills required
• Promote teamwork and effectively collaborate with key internal and external constituents