RN Case Managers
Torrance, CA, United States On-site
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About the role
Minimum of recent 2 years combined case management or clinical experience providing direct patient care and utilization review/case management experience in an acute care environment Working knowledge in the use of InterQual, Meditech, Medicare or other medical management guidelines. Knowledge of legislative requirements, NCQA guidelines and health plan delegation requirements for utilization management. Thorough knowledge of health care industry, benefit interpretation, professional/facility reimbursement methodologies, contracts and flow of related information. Must have strong problem solving skills. Ability to analyze problems and formulate plans, solutions and a course of action.
What you'll bring
- Must have strong problem solving skills.
- Experience Required- 2 to 5 Years
- Active CA License
- current BLS Certification
- 1 year minimum acute care experience required