- Nurse Case Manager
- Monday - Friday; 8/hr/day
- Medical Management Office
About the Job:
- Manages a caseload of patients by assessing the individual's needs made by the PCP/Specialist.
- Utilization Review, Concurrent Review, Discharge Planning
- Reviews, verifies and processes requests for referrals, inpatient and outpatient procedures, home health services, DME
- Strong problem solving and organizational skills
- DRG and ICD-9, CPT coding
- Guidelines and regulations relevant to Case Management and/or Utilization Management.
- Principles and practices of Health Care, Health Care Systems, and Medical Administration.
- A general knowledge of Medicare, Medicaid/MediCal utilization rules or where to find such rules/guidance
- InterQual and/or Milliman Familiar a Plus!
- California Nursing License RN or LVN
- At Least Two Years Experience
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!