California Licensed Case Manager
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Job Summary
Conducting concurrent utilization management reviews for hospitalized and acute care patients, the full-time California Licensed Case Manager will assess clinical status, collaborate with care teams, and ensure timely transitions and discharge planning while working remotely.
Key responsibilities
- Conduct concurrent utilization management reviews to evaluate medical necessity and appropriateness of care
- Collaborate with healthcare teams and stakeholders to identify barriers to care progression and facilitate discharge planning
- Maintain accurate documentation to support medical necessity determinations and ensure regulatory compliance
Required qualifications
- Graduate of an accredited school of nursing
- California RN License
- Minimum of 2 years of experience in acute care case management or health plan case management/utilization management
- Comprehensive knowledge of Utilization Review and levels of care
- Understanding of laws and regulations affecting case management practice in an integrated delivery system
Complete Job Description
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