Ambulatory Case Manager – Office Setting
Responsible for the care management (coordination of outpatient care) of members with catastrophic illnesses and the chronically ill while ensuring that quality standards are met by using clinical judgment to evaluate and assess.
Apply case management concepts, principles, and strategies to develop a Plan of Care (Care Plan) that addresses the member’s needs and limits patient hospitalization
Telephonic assessments ensuring members receive all necessary care allowed under their benefit plan.
Review of medical records and/or other documentation to determine medical necessity, appropriateness and level of stay utilizing Milliman Care Guidelines
Update PCP, healthcare providers, Medical Directors, health services staff and social workers regarding member’s status.
Assist in the identification and reporting of potential quality improvement issues.
California Nursing License (Registered Nurse RN)
About the Agency:
Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information!