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Registered Nurse (RN), Case Manager, Utilization Management - FT/Days

Company: MemorialCare Health System
Location: Laguna Hills
Posted on: June 12, 2021

Job Description:

Purpose Statement / Position Summary

The RN Care Manager is responsible for utilization review, multi-disciplinary care coordination and transition planning, for an assigned patient caseload. Role functions include: clinical assessment, payor communication for needed authorizations, and implementation of a patient / family centered plan of care across the continuum, to ensure optimal patient outcomes, including safe and timely transitions. The success of the department is inherent in the individuals' ability to demonstrate positive, professional communication with patients/families, physicians, and other providers, and to meet / exceed benchmarks for quality outcomes, and financial targets.

Experience

  • Prefer minimum 2-3 years Acute Hospital Nursing and 1-2 years Case Management and Utilization Review and Discharge Planning experience.
  • Milliman Care Guidelines utilization highly desirable.

Education

  • Current RN License in the State of California and BLS is required.
  • Prefer: Bachelor's Degree in Nursing or higher.
  • Certified Case Manager (CCM) highly desirable.

Keywords: MemorialCare Health System, Los Angeles , Registered Nurse (RN), Case Manager, Utilization Management - FT/Days, Other , Laguna Hills, California

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