Case Management - Nurse, Senior
By Blue Shield of California At , Rancho Cordova, 95670 $85,360 - $128,040 a year
Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD)
Requires at least 5 years of prior experience in nursing, healthcare or related field
Extensive knowledge of evidenced based clinical practice guidelines particularly for chronic conditions.
Knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care and length of stay criteria sets desirable.
Design appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomes