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Looking for LVN/RN for case manager
등록일 : 11-09-2018 조회수 : 56 관심글

채용정보

지역 : Anaheim/CA
직종 : 의료 근무형태 : Full time
경력 : 무관 연봉/급여 : 협의

Looking for LVN/RN for case manager

 

Area : Anaheim


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 (Milliman) and benefit determination.

·         Work under the direct supervision of UM/Case Management Manager and Medical Director.

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.

Qualifications and Skills

Basic Qualifications:

·         Current and unrestricted RN or LVN License in the State of California.

·         3 years of 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

 

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