California Licensed Care Manager II

Job Summary

Facilitating utilization management processes, the full-time California Licensed Care Manager II will evaluate admission appropriateness, ensure timely patient transitions, and coordinate care with treatment teams while working remotely.

Key responsibilities:

• Conduct concurrent reviews to assess the appropriateness of admissions and levels of care
• Resolve care delays and coordinate patient transitions in collaboration with the Facility Acute Care Manager
• Provide clinical information to third-party payers to ensure reimbursement for services rendered

Required qualifications:

• Graduate of an accredited school of nursing
• California RN licensure upon hire
• Minimum of 2 years of relevant experience in utilization management or care management
• Knowledge of healthcare reimbursement systems and regulations affecting case management
• Proficiency in using evidence-based criteria such as InterQual and/or MCG for utilization reviews