Registered Nurse , Case Manager II - Cap Utilization Management - Part-Time/Evenings

Employment Type

: Part-Time


: Miscellaneous

Position Summary:To provide safe, cost-effective patient care through the health experience, according to established standards utilizing the nursing process, within the scope of practice of Registered Nursing. The case manager is a licensed professional who coordinates and facilitates the ongoing care and appropriate discharge plan of a specific caseload of patients through the continuum of care. The case manager collaborates with members of the health care team, the patient, and their family to assure effective, efficient, and appropriate care and outcomes. Fiscal responsibilities include management of utilization, providing clinical information to payors and assuring appropriate reimbursement.Qualifications/Experience/Education:* This position requires strong verbal and written communication skills with the ability to communicate well with people from diverse socioeconomic backgrounds. The case manager is knowledgeable of criteria for medical necessity for each level of care through the continuum of care. A knowledge of reimbursement related to MediCare, MediCal, Capitation, and Managed Care is required* Three years experience in clinical field of expertise with two years experience in an acute setting is preferred.* Current California RN License required* Current California License in field of expertise.* Bachelors degree in health related field.

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