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구인 정보
Nurse Case Manager
등록일 : 08-01-2022 조회수 : 1,018 관심글

채용정보

지역 : Buena Park/CA
직종 : 일반사무 근무형태 : Full time
경력 : 무관 연봉/급여 : 협의

Nurse Case Manager

 

About Us

PremierOne Plus MSO (POPMSO) is a management service organization serving the needs of providers in a managed care setting. PremierOne Plus MSO provides you with the resources and opportunity to build a rewarding career in an environment that support your success.

 

Description

•​ Responsible for utilization management, utilization review, or concurrent review (telephonic inpatient care management)

•​ Perform reviews of current inpatient services and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines (MCG) and benefit determination

•​ Perform medical necessity and level of care reviews for requested medical services and refer to Medical Directors for review as appropriate depending on case development

Responsibilities and Duties

•​ Performing care management activities to ensure that patients move through the continuum of care efficiently and safely

•​ Assesses and interprets customer needs and requirements

•​ Reviewing cases and analyzing clinical information in conjunction with Medical Directors to determine the appropriateness of hospitalization

•​ Performing Nurse to Physician interaction to acquire additional clinical information or discuss alternatives to current treatment plan

•​ Escalating cases to the Medical Director for case discussion or peer-to-peer intervention as appropriate

•​ Performing anticipatory discharge planning in accordance with the patient`s benefits and available alternative resources

•​ Referring patients to disease management or case management programs

•​ Assisting with the development of treatment plans

•​ Documenting activities according to established standards

•​ Identifies solutions to non-standard requests and problems

•​ Solves moderately complex problems and / or conducts moderately complex analyses

•​ Works with minimal guidance; seeks guidance on only the most complex tasks

•​ Provides explanations and information to others on difficult issues

•​ Acts as a resource for others with less experience

•​ Works with less structured, more complex issues

•​ Update and review the case management and utilization management policies and procedures as needed

•​ Oversee the outpatient UM department

•​ Work on health plan initiated audits related to case management, utilization management, and related audits

•​ Submit and implement corrective action plans for issues identified during health plan audits

Qualifications and Skills

Basic Qualifications

•​ Current and unrestricted RN or LVN License in the State of California

•​ Clinical experience in an inpatient / acute setting

•​ ​Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

•​ Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

•​ Intermediate computer skills - Proficiency with Microsoft Word, Outlook and Internet Explorer, with the ability to navigate a Windows environment

Preferred Qualifications

•​ 1 year Utilization Management Inpatient experience

•​ Utilization Review experience

•​ Knowledge of or experience with Milliman Care Guidelines

•​ Experience in discharge planning or chart review

•​ Experience in acute long term care, acute rehabilitation, or skilled nursing facilities

•​ A background that involves utilization review for an insurance company or in a managed care environment

 

Resume submission : info330amm@gmail.com 

 

회사 정보

Healthcare Management