RN Case Manager

Ability and desire to advocate for patients and help them achieve their best health.

Flexibility and creativity in a newly-created role.

Support hospital discharge planning, transfers, provide education regarding member benefits, and authorize post-discharge items as medically necessary.

Identify barriers to efficient hospital utilization and facilitate resolution.

Serve as a liaison between the hospital, health plan, vendors, and providers.

Proactively and collaboratively, interface with clinics, HMOs, physicians, internal staff, members and their families to assist in expediting appropriate discharge.

Refer members to various other departments (i.e., Case Management, Disease Management, and Complex Case Management) for follow-up as appropriate.

Meet departmental review and documentation standards for work assignment.

Manage individual market to determine opportunities to improve utilization, quality of care, access issues and physician profiling.

Adhere to the policy and procedures of assigned hospital(s).

Build and maintain appropriate relationships on behalf of CHCN

Support a positive work environment and foster teamwork.

Utilization Management and Case Management experience, understanding and knowledge of healthcare benefits associated with various business lines (Medi-Cal, Medicare, and Commercial).

Active, unrestricted, California Nursing License (Registered Nurse)

Minimum three years of Medical clinical nursing experience

Minimum one year of UM/CM experience in hospital, HMO, or IPA setting.

Excellent communication, organizational and time management skills with the ability to meet tight timeframes.

Strong understanding of the managed care environment.

Travel to work assignments, appropriate individual automobile insurance must be maintained.