Case Manager (RN)

A Nurse Case Manager position is available immediately in Los Angeles, CA courtesy of Adecco Medical and Science. This is a 6+ month contract, full time position, Monday-Friday with flexible hours. Pay is negotiable.


The Case Manager is responsible for the coordination of care and services. The Case Manager effectively collaborates directly with the Member, Member's Family, and Interdisciplinary Care Team to achieve consensus and promote positive Member health outcomes through the assessment, planning, implementation and evaluation of the Member’s Care Plan. The Case Manager identifies gaps in care and coordinates the available resources required to meet the Member's health care needs through clear communication and advocacy that aims to promote quality cost-effective interventions based on medical necessity and compliance with the Member’s Health Plan.

Responsibilities:

• Works with Members and their families to understand the illness or injury and collaborates to develop individualized care plans with healthcare goals that aim to produce the best health outcomes for the Member.

• Develops and implements Member centric interventions based on accurate assessments of the Member’s physical, functional, behavioral, and social needs, and current or proposed treatment plans in accordance with evidence based and clinical practice guidelines.

• Demonstrates sound clinical judgment and independent analysis to identify and navigate barriers that may prevent Members from achieving their healthcare goals.

• Applies detailed knowledge of established medical and departmental policies, clinical practice guidelines, community resources, and contractual and community care standards.

• Works with medical groups and individual providers to ensure continuity of care and implement effective discharge planning activities appropriate for the member’s needs.

Education and Credentials
• Current, Active, Unrestricted California Registered Nurse License required
• Bachelor of Science in Nursing or advanced degree preferred.
• Certified Case Manager (CCM) preferred or obtained within two years of hire.

Experience:
• Requires 5-7 years of nursing experience, health care, or related field, with 3 years managed care experience preferred.
• Demonstrated competence in Case Management in accordance with CMSA Standards of Practice for Case Management.
• Demonstrated ability to independently assess, evaluate, and interpret clinical information and care planning.
• Understanding of community resources, treatment options, home health, funding sources and special programs.
• Knowledge of evidenced based clinical practice guidelines particularly for chronic conditions.
• Knowledge of Prior Authorization, Utilization Management, levels of care, and length of stay criteria preferred.
• Knowledge of regulatory/accreditation standards desirable (URAC, NCQA, DMHC, CMSA).


If you are interested in this Nurse Case Manager position then please click APPLY NOW. For other opportunities available at Adecco Medical and Science go to www.adeccousa.com.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled



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Reference number US_EN_2_108218_334189