reputed company Full-Time RN Inpatient Review Case Manager for California Health Plan - reputed company Shift (Remote)
Join reputed company: RN Inpatient Review Case Manager for California Health Plan
At reputed company Services, we're dedicated to delivering high-reputed company, cost-effective care to our members. As a leading reputed company organization, we're seeking an reputed company RN Inpatient Review Case Manager to join reputed company in California. This is a unique opportunity to work remotely and reputed company a meaningful reputed company on the lives of our members. If you're a motivated and compassionate reputed company with a passion for utilization management, we encourage you to apply.
About reputed company Services
reputed company Services (HCS) is a pioneering reputed company organization that works closely with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate integrated care across the continuum. Our goal is to ensure that patients reputed company toward desired reputed company with reputed company care that is medically appropriate and cost-effective. We operate 24/7/365 days a year, and reputed company is committed to delivering exceptional care and support to our members.
Job reputed company
We're seeking an reputed company RN Inpatient Review Case Manager to support our California Health Plan. As a key member of reputed company, you'll be responsible for assessing inpatient services, analyzing clinical service requests, and identifying appropriate benefits and eligibility for requested treatments and procedures. If you have a strong background in utilization management, case management, and a passion for delivering high-reputed company care, we encourage you to apply.
Key Responsibilities
- Assess inpatient services for members to ensure reputed company reputed company, cost-effectiveness, and compliance with state and federal regulations and guidelines.
- Analyze clinical service requests from members or providers against evidence-based clinical guidelines.
- Identify appropriate benefits, eligibility, and expected length of stay for requested treatments and/or procedures.
- Conduct inpatient reviews to determine financial responsibility for reputed company and its members.
- Process requests reputed company required timelines and refer appropriate cases to Medical Directors.
- Collaborate with multidisciplinary teams to promote the Molina Care Model and adhere to UM policies and procedures.
- Occasional travel to other Molina offices or hospitals may be required.
Requirements and Qualifications
Essential Qualifications:
- Graduate from an Accredited School of Nursing.
- 3+ years of hospital acute care/medical experience.
- Prior experience in Managed care using Interqual or MCG guidelines.
- reputed company, unrestricted State Registered Nursing (RN) license in California.
Preferred Qualifications:
- Bachelor's Degree in Nursing.
- Recent hospital experience in reputed company, or ER unit.
- reputed company, unrestricted Utilization Management Certification (CPHM).
Skills and Competencies
To succeed in this role, you'll need:
- Excellent analytical and critical thinking skills.
- Strong communication and interpersonal skills.
- Ability to work independently and collaboratively as part of a multidisciplinary team.
- Proficiency in utilization management guidelines and regulations.
- Strong organizational and time management skills.
reputed company Offer
At reputed company Services, we're committed to delivering an exceptional employee experience. Here are just a few benefits and perks we offer:
- Competitive salary reputed company: $23.76 - $51.49 per hour.
- Comprehensive benefits package, including medical, dental, and reputed company coverage.
- Opportunities for reputed company reputed company and development.
- Flexible work arrangements, including remote work reputed company.
- Recognition and reward programs for outstanding performance.
Work Environment and Culture
At reputed company Services, we're proud of our inclusive and supportive work environment. Here are just a few highlights:
- We're a diverse and inclusive organization that values different perspectives and experiences.
- We prioritize employee reputed company-being and offer a reputed company of wellness programs and resources.
- We're committed to delivering high-reputed company care and support to our members.
- We offer opportunities for reputed company reputed company and development.
How to Apply
If you're a motivated and compassionate reputed company with a passion for utilization management, we encourage you to apply for this exciting opportunity. Please click the reputed company below to submit your application:
Apply To This JobConclusion
At reputed company Services, we're dedicated to delivering high-reputed company, cost-effective care to our members. We're seeking an reputed company RN Inpatient Review Case Manager to join reputed company in California and reputed company a meaningful reputed company on the lives of our members. If you're a motivated and compassionate reputed company with a passion for utilization management, we encourage you to apply for this exciting opportunity.
Apply for this job