RN Case Manager - Full-time / Part-time

Will be going to clinical sites, working with providers and their staff, and reviewing medical documents.

Environment: Individual and team work. Acute Care - Hospital Setting

Must have: At least (1) Year(s) of Utilization Review experience as an RN, strong communication, problem solving abilities, Interqual experience, and Microsoft Office (Word -- for notations, Excel - creating logs, and Outlook - calendar and email), assertive, and organized.

Prefer: Medical Record Keeping System Experience, RN, Case Management

MUST BE: RN

Phone interviews:Please place candidate's availability at the top of their resumes.

Summary: Works with the Utilization Management and Case Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Health care members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Essential Functions: Provides concurrent review and prior authorizations (as needed) according to hospital policy for hospital members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for hospital members including Behavioral Health and Long Term Care and Acute Care. Maintains department productivity and quality measures. Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to Molina medical directors regularly, as necessary. Complies with required workplace safety standards. Knowledge/Skills/Abilities: Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously. Knowledge of applicable state, and federal regulations. In depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA. Ability to take initiative and see tasks to completion. Computer Literate (Microsoft Office Products). Excellent verbal and written communication skills. Ability to abide by Hospital policies. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers. Required Education: Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree).

Job Description:

Experience:

• Possession of a valid RN license issued by the State of California. Possession of a valid State of California driver's license. Two (1) year of Utilization Management/Case Management, or related experience in a managed care setting within an acute care setting. Experience documenting and resolving Member grievances and appeals, regulatory agencies, Medi-Cal and Medicare preferred.
• When patients are admitted, the care manager communicates with them to assess their needs and then consult with health professionals to decide on which services to provide. Additionally, these care managers may contact insurance companies to determine a patient's plan coverage.
• Specialized managers may inform patients regarding general preventative care practices as well as individualized care plans. Heath information managers keep track of patient's records, especially electronic records, and must keep current with computer technology, software, security measures, and legislation regarding patient privacy and other issues.

Work Environment:

• office environment, Hospital

Qualifications:

Knowledge/Skills:

• Expertise in computer data entry with knowledge in Microsoft Applications. Excellent writing and grammar skills. Excellent communication, interpersonal, and organizational skills; understanding of and sensitivity to multi-cultural community, telephone courtesy, high degree of patience. Timely and accurate processing of all written and telephonic communications. Requires limited auto travel within the Inland Empire/Los Angeles County. Strongly committed to positive team culture.

Performance Expectations:

• When patients are admitted, the care manager communicates with them to assess their needs and then consult with health professionals to decide on which services to provide. Additionally, these care managers may contact insurance companies to determine a patient's plan coverage.
• Specialized managers may inform patients regarding general preventative care practices as well as individualized care plans. Heath information managers keep track of patient's records, especially electronic records, and must keep current with computer technology, software, security measures, and legislation regarding patient privacy and other issues.

About Aerotek:

Our people are everything. Since 1983, Aerotek has become a leader in recruiting and staffing services by building quality relationships that allow us to place quality people in quality jobs. With over 230 non-franchised offices, Aerotek serves 17,000 clients and 300,000 contract employees every year. To learn more, visit .

Aerotek is acting as an Employment Agency in relation to this vacancy.