California Licensed Case Manager

Job Summary

To support patient wellness and care outcomes, the full-time California Licensed Case Manager will conduct utilization management reviews, coordinate discharge planning, and facilitate post-acute care referrals while working remotely.

Key responsibilities

• Conduct preauthorization, concurrent, and retrospective utilization management reviews to ensure medical necessity and appropriate levels of care
• Coordinate resource management, discharge planning, and post-acute care referrals for patients with complex health needs
• Promote cooperation and collaboration among patients, families, physicians, and healthcare team members to enhance patient care and experience

Required qualifications

• Associate Degree in Nursing from an accredited school
• California RN (Registered Nurse) license
• 2 years of recent relevant experience in case management
• CCM (Certified Case Manager) certification may be required within 2 years of hire
• Comprehensive knowledge of Utilization Review and regulatory compliance in healthcare