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Case Management Intermediate - (27584-1 ESG)

El Segundo, California | Contract

Job ID: 55894 Position: Case Management, Registered Nurse Branch: Rancho Cordova

Wollborg Michelson is supporting a large healthcare organization and we are currently recruiting for a Case Manager. The Case Manager' s primary responsibilities for the position include:
  • Independent use of criteria to determine if medical groups are compliant with regulatory, legislative and company' s  mandated requirements
  • Ability to develop and implement Corrective Action Plans (CAP) for medical groups that are out of compliance with delegated responsibilities, with timely follow up actions of CAP
  • Develop and implement recommendations for improvement of quality and cost savings
  • Ability to interpret statistics and plan for actions taken to improve utilization management
  • Ability to stay current on regulatory changes and industry requirements.
  • Participate in industry collaborative teams as needed.
  • Respond to questions from Medical Groups/IPAs and provided needed guidance.
  • Ability to design and implement tools and materials that are compliant with regulatory, legislative and Blue Shield mandated requirements
  • Ability to design work plans and workflows to facilitate the audit, quality and cost of healthcare initiatives
  • Collaborate with internal business partners relating to Medical Groups/IPAs

Key attributes for an individual to be successful in this position include being:
  • Highly motivated
  • Ability to work independently
  • Action/results oriented
  • Strong interpersonal and negotiation skills
  • Strong verbal and written communication skills
  • Intermediate level computer skills
  • Strong organizational skills

Job Required Education/Experience Requirements:
  • Current California RN license and five to seven plus years relevant experience or equivalent combination of education and experience.
  • Generally requires B.A. degree or equivalent.
  • In-depth knowledge of concepts, practices and procedures within the healthcare field, especially HMO.
  • Strong understanding of NCQA, CMS, and DMHC regulations and audit requirements.
  • Good clinical documentation and computer skills.
  • Strong communication and negotiation skills.
  • Previous experience in auditing strongly preferred.

Alana Klingman
Recruiter

Alana is a native Huntington Beach resident making the move to Sacramento just a few years ago. She comes with over 15 years of experience in full cycle healthcare recruiting and thoroughly enjoys every aspect of her job. Receiving a new client order and placing a qualified applicant is truly an excitement each and every time. Her goal at the end of every day is to leave a positive impression with everyone she works with including letting the candidates know that she is on their side. She strives to fill every client need that comes across her desk with a candidate that can call that place of business HOME. When she is not hard at work Recruiting, Alana spends her free time attending local family events, trying new eateries and perfecting DIY home projects she found on Pinterest.

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