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Utilization Review/Case Manager RN

Company: Palomar Health Medical Group
Location: Escondido
Posted on: May 14, 2022

Job Description:

We are looking for a Utilization/Case Manager RN to support our Utilization Management department. The Case Manager is responsible for case management of managed care clients, including complete accountability for coordination of skilled client care, case management, supervision, documentation and administration functions throughout the continuum of care. The Case Manager follows rules, policies, procedures, applicable laws and standards addressed in the compliance program.A qualified candidate will meet the following requirements:

  • Bachelors Degree / RN,
  • Must have current CA RN license.
  • Previous Utilization Management experience preferredThe following are essential job duties:
    • Provide appropriate case management activities related to the area of expertise and as assigned
    • Mentors/educates, assists member services with questions related to referrals, management of requests and daily office processes
    • Monitor discharge planning for in-patient, skilled nursing and home health functions, as assigned
    • Reports progress and changes of client's condition to appropriate physician and mid-level in area of expertise. Includes dictation, reports, and updates as needed
    • Establishes and maintains effective communication between providers and practitioners
    • Communicates and works cooperatively with other members and professionals within work environments such as member services, hospital, skilled nursing, home health, and disease management environments, as assigned
    • Initiates and facilitates conference on a regular basis with all appropriate caregivers regarding client progress, as appropriate for assigned area
    • Clerical filing, faxing, sorting, mailing, ordering equipment and supplies as needed
    • Obtaining authorization numbers and eligibility verifications as appropriate for setting
    • Scheduling of appointments for clients as needed#IND123

Keywords: Palomar Health Medical Group, Escondido , Utilization Review/Case Manager RN, Healthcare , Escondido, California

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