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Case Manager (LVN or RN)
Ref No.: 18-00375
Location: orange, California
Leading Managed Care organization with a highly professional office environment is seeking a Case Manager (RN or LVN) for a mostly (70%) telephonic role.

Case Manager (RN or LVN)

Job Description:
  • Manage the utilization of healthcare services and resources for each patient across our continuum of care.
  • Obtain appropriate clinical review on all admissions, to determine medical necessity for acute hospitalization and SNF and sub-acute admissions.
  • Visit contracted hospitals on a regular basis to assist with patient throughput, develop relationships with hospital staff, and assist hospitalist with task necessary to facilitate a timely discharge.
  • Liaison with Medical Director for review of all acute inpatient cases daily.
  • Actively participate in referrals to appropriate Disease Management Programs and identify/'report patients with high risk needs that would benefit from our case management programs.
  • Participates in Quality Assurance Programs as needed

  • CA LVN or RN
  • Must have prior Case Management experience in Managed Care or Hospital environment
  • Excellent communication skills when interacting with physicians, patients, and service providers
  • Working knowledge of NCQA, CMS and health plan requirements related to Utilization and Quality Management.

  • Competitive Salary, flexible based on experience
  • Full benefits package which includes employer paid medical, pharmacy and dental benefits. Generous PTO package, 401k Retirement Savings, Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement & Licensed Renewal Fees for clinical staff