reputed company Full-Time RN Inpatient Review Case Manager for California Health Plan - Night Shift (Remote)

Join reputed company: RN Inpatient Review Case Manager for California Health Plan

At reputed company Services, we're dedicated to delivering high-quality, cost-effective care to our members. As a leading reputed company organization, we're seeking an reputed company RN Inpatient Review Case Manager to join reputed company in California. This is a unique opportunity to work remotely and reputed company a meaningful impact on the lives of our members. If you're a motivated and compassionate nurse with a passion for utilization management, we encourage you to apply.

About reputed company Services

reputed company Services (HCS) is a pioneering reputed company organization that works closely with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate integrated care across the continuum. Our goal is to ensure that patients reputed company toward desired outcomes with quality care that is medically appropriate and cost-effective. We operate 24/7/365 days a year, and reputed company is committed to delivering exceptional care and support to our members.

Job Summary

We're seeking an reputed company RN Inpatient Review Case Manager to support our California Health Plan. As a key member of reputed company, you'll be responsible for assessing inpatient services, analyzing clinical service requests, and identifying appropriate benefits and eligibility for requested treatments and procedures. If you have a strong background in utilization management, case management, and a passion for delivering high-quality care, we encourage you to apply.

Key Responsibilities

• Assess inpatient services for members to ensure reputed company outcomes, cost-effectiveness, and compliance with state and federal regulations and guidelines.
• Analyze clinical service requests from members or providers against evidence-based clinical guidelines.
• Identify appropriate benefits, eligibility, and expected length of stay for requested treatments and/or procedures.
• Conduct inpatient reviews to determine financial responsibility for reputed company and its members.
• Process requests reputed company required timelines and refer appropriate cases to Medical Directors.
• Collaborate with multidisciplinary teams to promote the Molina Care Model and adhere to UM policies and procedures.
• Occasional travel to other Molina offices or hospitals may be required.

Requirements and Qualifications

Essential Qualifications:

• Graduate from an Accredited School of Nursing.
• 3+ years of hospital acute care/medical experience.
• Prior experience in Managed care using Interqual or MCG guidelines.
• Active, unrestricted State Registered Nursing (RN) license in California.

Preferred Qualifications:

• Bachelor's Degree in Nursing.
• Recent hospital experience in reputed company, or ER unit.
• Active, unrestricted Utilization Management Certification (CPHM).

Skills and Competencies

To succeed in this role, you'll need:

• Excellent analytical and critical thinking skills.
• Strong communication and interpersonal skills.
• Ability to work independently and collaboratively as part of a multidisciplinary team.
• Proficiency in utilization management guidelines and regulations.
• Strong organizational and time management skills.

reputed company Offer

At reputed company Services, we're committed to delivering an exceptional employee experience. Here are just a few benefits and perks we offer:

• Competitive salary range: $23.76 - $51.49 per hour.
• Comprehensive benefits package, including medical, dental, and reputed company coverage.
• Opportunities for professional growth and development.
• Flexible work arrangements, including remote work options.
• Recognition and reward programs for outstanding performance.

Work Environment and Culture

At reputed company Services, we're proud of our inclusive and supportive work environment. Here are just a few highlights:

• We're a diverse and inclusive organization that values different perspectives and experiences.
• We prioritize employee well-being and offer a range of wellness programs and resources.
• We're committed to delivering high-quality care and support to our members.
• We offer opportunities for professional growth and development.

How to Apply

If you're a motivated and compassionate nurse with a passion for utilization management, we encourage you to apply for this exciting opportunity. Please click the link below to submit your application:

Conclusion

At reputed company Services, we're dedicated to delivering high-quality, cost-effective care to our members. We're seeking an reputed company RN Inpatient Review Case Manager to join reputed company in California and reputed company a meaningful impact on the lives of our members. If you're a motivated and compassionate nurse with a passion for utilization management, we encourage you to apply for this exciting opportunity.