Case Manager (RN)

New

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

Job Description:

Working with complex cases promotes the delivery of quality; cost-effective health care services based on medical necessity and contractual benefits. Works with other members of HCS team, provider, hospitals, IPA/MGs, members and their families to plan and review medical necessity, intensity of services, level of care, length of stay and general appropriateness of care. Provides guidance to the provider network. Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care. Will provide case management to member segments with chronic/ catastrophic illness and/or transplant candidates and recipients.


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 Blue Shield’s 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.
• 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).

Requirements:


Current, Active, Unrestricted California Registered Nurse License required
Bachelors of Science in Nursing or advanced degree preferred.
Certified Case Manager (CCM) preferred
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.
2+ years of UM health plan/ IPA /Med Group experience, prior authorization and concurrent review required.
Clinical experience – oncology, ICU, CM, and/or transplant. Transplant experience preferred.



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. If you have questions about the position, please contact Lia Vyverberg at lia.vyverberg@adeccona.com.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled



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Reference number US_EN_2_108218_333662