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.
Evaluating the pre-service authorization request. Promoting the quality cost-effectiveness of medical care. Forwarding requests to the appropriate physician or medical director with recommendations for other determinations. Qualifications for this position include:
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.
Reviewing proposed medical care cases for medical necessity against established CMS Coverage Guidelines. Qualifications for this position include: Travel: Yes, 10 % of the Time. BSN or Bachelor's degree in a related field. Active RN license in the state in which the nurse practices.
Core Responsibilities Include: Performing assessment and utilization review for medical requests. Identifying, coordinating, and implementing high quality, cost-effective alternatives. Supporting physician decision-making. Position Requirements Include:
Reviewing and analyzing reports, records, and medical documents/charts. Coordinating quality management and HEDIS related programs and activities as required. Qualifications Include: Travel Yes, 25 % of the Time. Clinical RN with current, unrestricted license in PA.
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:
Provide CRM consultations for insureds as needed, both medical, dental, healthcare professionals. Provide content for new and ongoing CRM informational products and services. Develop relationships that will strengthen ties with customers or prospects. Position Requirements Include: