RN Case Manager

ID: 645118
Type: Contract
Location: Los Angeles, CA
Contact Email: AWhiteman@judge.com
Salary: Open
Our client is currently seeking a RN Case Manager to perform a blended function of utilization management (UM) and case management (CM) activities

This job will have the following responsibilities:
  • Researches and designs treatment /care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type. 
  • Implements discharge planning activities for medically complex cases. 
  • Determines appropriateness of referral for CM services. 
  • Provides Referrals to Quality Management, Disease Management and Appeals and Grievance department.
  • Conducts member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental cases.

Qualifications & Requirements:
  • RN licensed in California 
  • Previous Case Management experience at Health Plan, IPA or acute facility
  • 1 year experience in Ambulatory Care Management in a Health Plan or Medical Group. 
  • In office position, no remote.
  • CCM Certification desirable. 
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