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UM Review Nurse (RN)
Ref No.: 20-16568
Location: torrance, California
Case Management Nurse
 
Company Info:
 
  • IPA with strong commitment to helping its members stay healthy
  • Position will be Mon-Fri, business hours
 
Job Description:
 
  • Telephonic case management of members with high risk and chronic conditions. 
  • Assess, plan, implement, coordinate, monitor, and evaluate options and services to meet members health needs
  • Locate services and programs patient may be eligible for
  • Monitor patients with chronic diseases, recommend and assist with healthier lifestyle choices and other available resources to promote quality cost-effective outcomes.  
  • Act as a healthcare resource in order to help ensure members’ needs are being met.
  • Personalize assistance to members’ individual needs.
  • Provide valuable information and support to allow patient to make informed decisions.
  • Coordinate patient care with PCP, specialists, hospitals, health plans, interdisciplinary care team and patient's family.
  • Review medical records, authorizations and care plans.
  • May occasional conduct in-home assessments when appropriate.
  • Monitored changes in patient's health status.
  • Educated members regarding diagnosis and treatment plan
Qualifications:
 
  • Current unrestricted CA RN, CMC or CCM desirable
  • 2+ years of experience performing care coordination, utilization review, discharge planning and case management
  • Experience in a Managed Care or Home Health setting preferred
  • Good communication skills, and ability to read and understand health plan contracts
 
Compensation:
 
  • Competitive pay ($35-$45/hour depending on experience)
  • Full Medical Benefits package including PPO/HMO, 403A and 403B retirement, life insurance, etc
  • Paid Time Off