Job Opportunity Details

Job ID Specialty Geographic Location City State Recruiter
2367794 Case Manager 17 miles South of Santa Rosa Petaluma CA The Clinical Recruiter

Company Name: The Clinical Recruiter
Recruiter Name: Chris Monroe
Contact Phone: 615-547-2432

Job Title: Care Manager RN II

In HouseID:

Job Description

This is a Case Manager Opportunity Only!

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17 miles South of Santa Rosa    (Only QUALIFIED Healthcare Professionals accepted) Case Manager - Care Manager RN
Petaluma, California
JO# 29288

* $20,000 Sign On Bonus *
* Relocation Assistance *

General Summary:
The Manager of Case Management assumes 24-hour responsibility and assists with the direction, management, and evaluation of the Case Management|Social Work departments.
Reports to the Director of Case Management and assists with clinical, operational, and financial aspects of the Case Management|Social Work departments.
Manages all aspects of Case Management and Utilization Management, including admission and continued stay medical necessity reviews, payer authorization, discharge planning, denials management, and ensures adherence to the case management plan.
Assists with hiring, training, directing, development and evaluating of staff.
Assists with development of action plans, and may report outcomes to the Case Management Director, CNO, or others as applicable.
Assists with the design, implementation, training, and resources for the Case Management system for the organization.
Evaluates personnel, assesses environment, and determines priorities for care in order to plan, implement, and evaluate outcomes of care.
Evaluates the effectiveness of existing clinical protocols and pathways and makes recommendations for new ones.
Works effectively with MCO staff and leadership to decrease denials or downgrades in reimbursement.
Ensures collaboration among health care providers across the Continuum of Care to maximize effective access and efficient utilization of resources.

2 years Acute care clinical or comparative experience required
3 years Experience in community health nursing or case management preferred

Bachelor’s Degree in Nursing within 3 years of hire date required
Bachelor’s Degree in Nursing preferred

Certifications | Licensure:
California Registered Nurse License upon hire required
CCM upon hire preferred

Special Skills:
Must be able to use independent decision-making skills in a wide variety of situations
Frequent contact with employees, physicians, customers, community individuals and volunteers
Must be self-motivated to complete work in a timely manner to meet deadlines
Experience with Core Measures, Quality Indicators, Case Management, and Utilization
Knowledge base of InterQual criteria
Knowledge of Managed care trends, Medicare, and Medicaid regulations
Advanced negotiation and mediation skills


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