California Licensed Care Manager

Job Summary

Facilitating utilization management processes, the full-time California Licensed Care Manager will evaluate appropriateness of admissions, manage patient transitions, and coordinate care with treatment teams in a remote setting.

Key responsibilities

• Conduct concurrent reviews to ensure timely patient movement throughout the continuum of care
• Provide clinical information to third-party payers to assure reimbursement
• Collaborate with facility management and treatment teams to resolve care delays and issues

Required qualifications

• Graduate of an accredited school of nursing
• California Registered Nurse license upon hire
• Minimum of 2 years of relevant experience in utilization management or case management
• Knowledge of healthcare reimbursement systems and regulations affecting case management practice
• Proficiency in using Microsoft Office Suite and evidence-based medical necessity criteria such as InterQual or MCG