California Licensed Care Manager II

Job Summary

Facilitating utilization management processes, the full-time California Licensed Care Manager II will evaluate the appropriateness of admissions and care transitions while ensuring timely patient movement throughout the continuum of care, working remotely from Sacramento, California.

Key responsibilities:

• Conduct concurrent reviews to assess the appropriateness of admissions and continued hospitalization
• Coordinate care with treatment teams, patients, and families to resolve delays in service or transitions
• Provide clinical information to third-party payers to ensure reimbursement for services rendered

Required qualifications:

• Graduate of an accredited school of nursing
• California RN license upon hire
• Minimum of 2 years of relevant experience in utilization management or case management
• Knowledge of healthcare reimbursement systems and regulatory compliance requirements
• Proficiency in using Microsoft Office Suite and familiarity with evidence-based level of care criteria such as InterQual or MCG