RN Case Manager

Company Description

Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

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.

Qualifications

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.

Additional Information