A healthcare management company is seeking a Remote Medical Case Manager in the Los Angeles County Area. Must be able to: Research and recommend resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals.
Initiating and conducting claims investigation in a timely manner. Managing medical treatment and medical billing, authorizing as appropriate. Skills and Requirements Include: 1 to 5 years related experience. Technical knowledge of statutory regulations and medical terminology.
Complex Case Management. 1-3 years in case management, disease management, managed care or medical or behavioral health settings. Active, unrestricted State Registered Nursing license in good standing. Must have valid driver's license with good driving record.
Coordinating medical care telephonically for injured workers. Developing a comprehensive case management plan to facilitate recovery and return to work. Working with a caseload of workers compensation claimants within a defined jurisdiction. Qualifications Include: Must work in the field.
Performing clinical and medical reviews, data collection and database entry. Assigning case reviews by identifying the issues for review. Facilitating quality improvement plan development and implementation. Position Requirements Include: Travel at least 10% of the time.
Ensure that medical record documentation accurately reflects the level of services rendered. Ensure clinical information is utilized in profiling and reporting outcomes is complete. Monitor and evaluate care to ensure costs are medically necessary. Skills and Requirements Include:
3+ years of case and/or utilization management experience. Experience in psychiatric and medical health care settings. Working knowledge of utilization review procedures. Familiarity with mental health community resources. Unrestricted license as a LIMHP, LCSW, LMFT, LPC, PhD, PsyD or RN.
Skills and Requirements Include: Master's Degree in Social Work. 1-3 years of experience. Understanding of plan benefit structures, psychiatric/medical terminology and local communication resources. Must meet the employer's certification and licensing requirements.
Analyze complex or technically difficult medical malpractice claims. Manage the total claim costs while providing high levels of customer service. Communicate claim activity and processing with the client and maintain professional client relationships. Position Requirements Include:
Engage members to develop lifelong well-being and health. Review actual and proposed medical care. Recommend services. Applicants must meet the following qualifications: Available to travel up to 10% Active RN license in the state(s) in which the nurse is required to practice.