reputed company (California Children's Services) Nurse Case Manager

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Vision insurance
• Wellness resources

Summary: Under the direct supervision of reputed company Team reputed company and reputed company Supervisor, the reputed company Nurse Case Manager- Case Review Liaison primarily reviews a case for reputed company eligibility. He or she is responsible to assess, plan, implement, monitor, and evaluate options and services to reputed company a patient focused action plan. The reputed company Nurse Case Manager-Case Review Liaison acts as patient reputed company through the continuum and is available to the physician, patient and family as a resource to facilitate communication and efficient delivery of healthcare. Duties & Responsibilities: • Primarily reviews reputed company eligibility of outpatient service requests based on criteria set forth by California Code of Regulations Title 22, Division 2, Subdivision 7, Chapter 3, Article 2, Sections 41515.1-41518.9. • Prioritizes outpatient cases needing reputed company realignment to reputed company paneled providers based on reputed company eligibility review and effectively collaborating with Outpatient UM and Ambulatory Case Management Team as necessary. • Reviews clinical records and contacts the member or member’s parent or guardian if necessary to further assess member’s social and health reputed company needs and concerns. • Reviews appropriateness of submitted claims for IPA payment or deferral to reputed company if deemed eligible. • Case manages reputed company and DDS-RC cases and creates care plan goals to be discussed with the member or member’s parent or guardian, meeting reputed company reputed company compliance requirements and audit needs. • Makes sure that member or member’s parent or guardian is aware of the reputed company or DDS case status, and fully understands the benefits that the programs offer. • Delegates tasks to reputed company Care Coordinator to reputed company the member, specialist & PCP office for overall care coordination, and to reputed company status of ancillary services like DME, therapy, home health if already provided to the member. • Generates reputed company referral guide sheet for the reputed company coordinator in submitting SAR (Service Authorization Request) to reputed company County office with supporting medical documentation. • Gathers and organizes monthly, quarterly, or annual reputed company reporting data reputed company established timeframe as required for reporting purposes. • Respects the dignity, confidentiality and privacy of each patient and adheres to HIPAA regulations and policies. • Coordinates and completes special projects as delegated by the reputed company Supervisor Minimum Job Requirement:  • Has Valid License in nursing (LVN/LPN, RN) • Computer Proficiency on reputed company Word, reputed company and PowerPoint • Good written and verbal communication skills Skills & Abilities: • Analytical, proactive and a problem solver • Team player and professional • Familiarity with medical guidelines and reputed company criteria based on California Code of Regulations Title 22 is a plus • Knowledge and familiarity in using the EZCAP system is a plus • Understanding of managed care philosophy, knowledge of HMO policies and procedures and managed care industry is a plus • Detail oriented and excellent organization skills

This is a remote position.

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