California Licensed RN Care Manager
Job Summary
To ensure high-quality patient care while efficiently utilizing medical resources, the part-time California Licensed RN Care Manager will conduct clinical reviews of acute medical patients, collaborate with healthcare providers and insurance companies, and maintain productivity and quality metrics in a remote setting.
Key responsibilities
- Completes clinical reviews using the Optum/Inter Qual tool to assess the appropriateness of treatments and length of stay for patients
- Collaborates with healthcare professionals to develop comprehensive patient care plans and facilitates communication among patients, healthcare teams, and insurance providers
- Participates in required training and meets departmental productivity and quality audit metrics within specified timelines
Required qualifications
- Associate's Degree in nursing or equivalent combination of education and related experience
- Five years of acute hospital experience, preferably in critical care areas
- Two years of utilization review experience using the Optum/Inter Qual product within the last 12 months
- Registered Nurse (RN) licensure in the state of practice
- Bachelor's Degree in Nursing (BSN) is preferred
Complete Job Description
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