Providence is calling a Inpatient RN Case Manager ( Full Time / Day Shift ) to our Providence Facey Medical Foundation Case Management Department located in Mission Hills, CA.
In this position you will be responsible for providing:
- Responsible for utilization review and discharge planning for capitated patients who are hospitalized.
- The review includes coordination of services for medical necessity, cost effectiveness, timelines of service and ensuring that quality standards are met.
- Performs coordination of services for patients whose health plan has an at-risk agreement to ensure that services are medically necessary, cost effective, provided in a timely manner and meet local standards or care.
Required Qualifications for this position include:
- RN graduate of an accredited school of nursing.
- Current California RN license
- American Heart Association BLS for Health Care Providers.
- Must possess excellent customer service and communication skills.
- Must be organized and a self‑starter.
- Must have extensive knowledge of health plan requirements and benefits as applied to the utilization and case management process and clinical decision making.
- Must have working understanding of MS Outlook, Word and Excel and be capable of being trained in referral processing software.
- Needs to be able to access and applyall appropriate clinical guidelines approved by Health Plan, Medicare / MediCal or other payor resourceto patient cases requiring prior authorization.
- Needs to be aware of Health Plan criteria regarding timeliness of referrals, denial rationale and denial language.
- Must possess strong oral and written communication skills, problem solving and analytical skills as related to Utilization Management.
Preferred Qualifications for this position include:
- Three to Five years' experience preferred in a managed care setting/utilization review/discharge planning/case management of which two years is in hospital or ambulatory case management.
About the organization you will serve:
Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago.
Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Location: California-Mission Hills
Req ID: 153544