RN UM Case Manager - 1 Temp and 1 Permanent Opportunity!!!

Apply by eMail:15330776.185@jobfrenzy1.com

Description:
Two Fantastic Opportunities for outstanding RN Case Managers in Los Angeles - Perfect for RN Case Managers wishing to relocate to LA - one temp and one permanent/direct hire!!!

There is an opportunity to work for a leading healthcare plan organization, offering an excellent salary, generous benefits package, and job stability, for the right candidate. To be considered for this position, you must be experienced in case management, and utilization management. Duties will include assuring timely and accurate determination and notification of authorization, reconsideration and appeals requests. You will generate authorization, modifications and denials, to include member and provider notification of referral determination. Reviews pre-service, concurrent, and retro authorization cases, according to established medical guidelines. Work closely with UM Manager or designee to discuss all concurrent cases on a daily basis. Monitor and oversee the collection and transfer of data (medical records), referral requests by IPA, and identification of under and over-utilization by providers. Act as a department resource for medical services request/referral management and processes. RN's only with min 5 years of UM Case Management experience. A working knowledge of Milliman, InterQual and other medical guidelines is necessary, as well as a minimum of 3 to 5 years Clinical Nursing background.

APPLY FOR THIS SUPERB OPPORTUNITY TODAY!!!

Requirements:
UM experience, particularly review of inpatient hospitalization.
Preferred:
3 years Managed Care
2 years Medi-Cal
2 years Utilization Management

Education: Not Specified

Experience: Not Specified

Travel: Not Specified

Apply by eMail:15330776.185@jobfrenzy1.com

Job Created: Fri Oct 16 2009 04:28:16 AM
Last Modified: Fri Oct 16 2009 04:28:16 AM