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UM Nurse - Case Manager - Tele...

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Job Summary

Company
Managed Care Resources (MCR)
Location
Van Nuys, CA
Industries
Insurance
Healthcare Services
Job Type
Full Time
Employee
Years of Experience
2+ to 5 Years
Education Level
Associate Degree
Career Level
Experienced (Non-Manager)
Contact Information
Managed Care Resources (MCR)
Phone:  310-470-4232
Fax:  310-475-4737

UM Nurse - Case Manager - Telephonic

About the Job

  1. Nurse Case Manager
  2. Monday - Friday; 8/hr/day
  3. 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


Knowledgeable of:

  1. DRG and ICD-9, CPT coding
  2. Guidelines and regulations relevant to Case Management and/​or Utilization Management.​
  3. Principles and practices of Health Care, Health Care Systems, and Medical Administration.​
  4. A general knowledge of Medicare, Medicaid/MediCal utilization rules or where to find such rules/guidance
  5. InterQual and/or Milliman Familiar a Plus!


Requirements:
  1. California Nursing License  RN or LVN
  2. 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!

 

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