Case Manager RN
Found in: Appcast Linkedin GBL C2 - 2 weeks ago
If you’re an RN, that’s tired of working weekends, nights, holidays or working long shifts, the trust for the Los Angeles County Fire Fighter’s, Local 1014, (located in El Monte, California) is hiring for a UR/UM Registered Nurse. The self-funded ERISA Trust dedicated to serving the well-being of the Fire Fighters, and their families. We are currently seeking to fill a full-time nurse position proficient in UR, case management, discharge planning and experienced in Workers’ Compensation. The ideal candidate should be extremely confident and will be trusted to make independent decisions. THIS IS NOT A REMOTE POSITION
We are looking for a candidate who can work in a highly collaborative place. Highly effective communication and writing correspondence will be highly important. The position is going to be strictly internal, and the position is slated for a 35 hour work week, 8:30- 4:30 Monday - Friday.
JOB SUMMARY
Optimize member benefits to promote effective use of resources. Conduct pre and post-payment review of inpatient admissions, outpatient services, and other procedures to assess the medical necessity and appropriateness of services on-site or in-house. Discuss cases with attending physician and other health care professionals. Prepare and refer concerns to the Administrative Manager.
ESSENTIAL JOB FUNCTIONS
- Conduct pre and post-payment review of inpatient admissions, outpatient services, and other procedures to assess the appropriateness and continuity of care.
- Apply all aspects of the medical review function, including pre-authorization, concurrent review, screening for quality of care issues, and discharge planning. Document rationale for medical decisions made.
- Identify at-risk members who would benefit from health management programs through comprehensive health assessments.
- Monitor and evaluate patient’s plan of care and identify potential issues through telephonic outreach. Recommend appropriate interventions.
- Promote member and provider satisfaction.
- Provide continuity and consistency of care by building positive relationships between member and family, physicians, provider, care coordinator, and health care plan.
- Represent Plan in a responsible and professional manner.
- Participate in department initiatives and projects.
- Perform other duties as assigned.
QUALIFICATIONS
Minimum Education and Experience
- Unrestricted California Nursing License
- 3 - 5 years of Acute medical or Clinical experience
- Must have strong experience in Utilization Management/Review.
- Valid Driver’s License (On-site only)
Preferred Education, Additional Qualifications and Experience
- Associates Degree in Nursing
- Certified Case Management certification, Certified Professional Utilization Review certification
- Experience working in a managed care/Workers Compensation organization
Required Knowledge, Skills and Abilities
- Understanding of utilization review techniques, all aspects of the medical review function, including pre-authorization, concurrent review and discharge planning
- Understanding of health care delivery system access points and services
- Correct application of health care management guidelines
- Ability to navigate the healthcare delivery system
- Advanced analytical skills, with the ability to interpret and synthesize complex data sets
- Negotiation skills
- Presentation skills
- Decision-making skills
- Good problem-solving skills
- Ability to interface with employees at all levels
- Excellent organizational skills and ability to successfully prioritize multiple tasks
Amazing Compensation & Benefits Package (all start day 1 of employment)
- $115K Annually (Based on 35hr work week)
- $10K bonus after 6 months
- 100% covered medical benefits for employee AND their dependents
- 7%-9% Retirement contribution option
- 13 holidays, 2 weeks vacation, 12 sick days
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