Registered Nurse Case Manager II

Quick Facts

• Role: Case Manager II, Registered Nurse

• Work schedule: Days, Monday–Friday

• Shift type: Per Diem/Casual

Description

Conducts preauthorization, concurrent, and retrospective utilization management reviews using department criteria to confirm medical necessity and appropriate level of care for ambulatory, acute, and post-acute patients. Coordinates utilization management, resource management, discharge planning, post-acute care referrals, and care facilitation to improve care outcomes and efficient utilization of health services.

Responsibilities

• Perform utilization management review (preauthorization, concurrent, retrospective)

• Coordinate utilization management and resource management

• Support discharge planning and post-acute care referrals

• Facilitate care for patients with complex health needs

Requirements

• Associate Degree in Nursing

• Graduate of an accredited school of nursing

• RN-Registered Nurse of California

• CCM - Certified Case Manager (may be required by entity; must be obtained within 2 years of hire)

• 2 years recent relevant experience

• Broad knowledge of health care delivery and case management in a managed care environment

• Comprehensive knowledge of Utilization Review, levels of care, and observation status

• Working knowledge of relevant laws, regulations, and professional standards, including CMS Grouper, Department of Managed Health Care, and NCQA

• Knowledge of outpatient, acute, and post-acute levels of care and associated regulatory compliance requirements

• Strong verbal and written communication; interpersonal communication and negotiation

• Ability to collaborate across patients/families/caretakers, physicians, nurses, and ancillary partners

• Ability to work independently and exercise sound judgment with physicians, payers, and patients/families

• Time management skills for a high-volume, rapidly changing environment

• Intermediate computer skills

Benefits

• Pay range: $90.58 to $126.81 per hour (base pay is part of total rewards)

• Comprehensive benefits package may apply to eligible positions