Case Manager Utilization Rn Jobs

Managed care experience or Case Management experience.

Provide utilization management as needed to ensure coordination of health care delivery.

Identify members at risk and refers for Care management and/or disease management as needed.

RN with an active, unrestricted nursing license (Concurrent Review, Medical Management, etc.)

Effectively able to screen and stratify members who are appropriate for care management services.

Ability to create and execute care management care plans and document per EH’s policies and procedures.

Two (2) years combined RN experience in an acute care setting or case management required.

Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.

Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management.

Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).

Recommends alternative levels of care and ensures compliance with federal, state and local requirements.

Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.