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Below are the detail of job "Registered Nurse (RN) -Telephonic Complex, Case Manager - Health Plan ":

JOB #   20A*
JOB TITLE   Registered Nurse (RN) -Telephonic Complex, Case Manager - Health Plan
JOB DESCRIPTION  

 Description

  1. Medical Group in Orange County
  2. RN Telephonic Case Manager (Managed Care) 
  3. Processing Prior Authorization (Referrals)
  4. Follow up Complex Telephonic CM
  5. Long Term Temp Assignment (Possible Perm if right fit)

 

QUALIFICATIONS  

About the Job:

  • Fast Paced Office Environment.

  • Monday - Friday, 40 Hours a Week, 8 Hours a Day

  • Reviews, verifies and processes requests for referrals, outpatient/inpatient procedures, home health services, DME, Imaging, etc.​ through the telephone & fax.​

  • Computer literate for electronic documentation and data entry

  • Strong problem solving and organizational skills in a fast paced environment

    Able to meet production and quality work standards

LOCATION   Santa Ana, CA
JOB TYPE   Temporary
REQUIREMENTS  

Knowledgeable of:

  • ICD-9, CPT and HCPCS coding, requirements for prior approval.

  • Effective charting practices and guidelines.

  • Guidelines and regulations relevant to case management and/or utilization management.

    Principles and practices of health care, health care systems, and medical administration.

 

 Requirements
  1. California (Current) (RN)

  2. At least Three years case management experience

  3. Ability to Interview Now

ADDITIONAL REQUIREMENTS   N/A
LICENSES/CERTIFICATIONS   Valid RN License (California)

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