Registered Nurse

New

A Nurse Case Manager position is available in El Dorado Hills, CA courtesy of Adecco Medical and Science. This is a full time position, with a shift of Monday-Friday 8-4:30pm. 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. May provide case management to member segments with chronic or catastrophic illness. Specific licensing requirements may apply depending upon position i.e. RN
Ability to function as above
Discharge planning for cases that exceed EOA or dx assigned to RN.
Follow-up with LLC coordination such as SNF, HH, HI, Rehab.
Referrals to QM, DM, CM and AGD
IPA oversight, Continuity of Care, Healthy Families activities, OOA/OON cases, invest/exp, POS
Other CM activities as identified

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.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled



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Reference number US_EN_2_108218_333910