Care Manager RN II - Case Management

Company: The Clinical Recruiter
Location: Santa Rosa
Posted on: January 13, 2022

Job Description:

(Only QUALIFIED Healthcare Professionals accepted) Case Manager-RN - Care Manager RN II - Case Management
Santa Rosa, California
JO# 30843

*$20,000 Sign-On-Bonus*
*Relocation Assistance*

Summary:
The Manager of Case Management assumes 24-hour responsibility and assists with the direction, management, and evaluation of the Case Management-Social Work departments.
Reports to the Director of Case Management and assists with clinical, operational, and financial aspects of the Case Management-Social Work departments.
Manages all aspects of Case Management and Utilization Management, including admission and continued stay medical necessity reviews, payer authorization, discharge planning, denials management, and ensures adherence to the case management plan.
Assists with hiring, training, directing, development and evaluating of staff.
Assists with development of action plans, and may report outcomes to the Case Management Director, CNO, or others as applicable.
Assists with the design, implementation, training, and resources for the Care Management system for the organization.
Evaluates personnel, assesses environment, and determines priorities for care in order to plan, implement, and evaluate outcomes of care.
Evaluates the effectiveness of existing clinical protocols and pathways and makes recommendations for new ones.
Works effectively with MCO staff and leadership to decrease denials or downgrades in reimbursement.
Ensures collaboration among health care providers across the Continuum of Care to maximize effective access and efficient utilization of resources.

Experience:
3 years Acute nursing experience, with evidence of progressive clinical experience preferred, or Case management experience required
Managed Care Organization (MCO) experience preferred
Environmental Orientation due within 30 days of hire required
General Nurse Competency due within 30 days of hire required

Education:
Bachelor of Science in Nursing (BSN) required
Masters Degree in Nursing or a related healthcare field preferred

Certifications-Licensures:
Registered Nurse License required
Certified Case Manager (CCM) required
Healthcare Quality of Utilization Review (HQUR) a plus, not required

Special Skills:
Must be able to utilize independent decision-making skills in a wide variety of situations
Frequent contact with employees, physicians, customers, community individuals and volunteers
Must be self-motivated to complete work in a timely manner to meet deadlines
Experience with Core Measures, Quality Indicators, CM and utilization
Knowledge base of InterQual criteria
Knowledge of Managed care trends, Medicare and Medicaid regulations
Advanced negotiation and mediation skills

Keywords: The Clinical Recruiter, Santa Rosa , Care Manager RN II - Case Management, Executive , Santa Rosa, California