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RN - Utilization Management (RC 23191)
Rancho Cordova, California | Contract
Registered Nurse - Utilization Management
Have you ever wanted to work in a position that you knew was helping others, and that will make a difference? If you are not then you are not working your dream job.
This is an opportunity to use your utilization management experience in a contract opportunity.
Working with complex cases promotes the delivery of quality; cost-effective health care services based on medical necessity and contractual benefits. Works with other members of the team, provider, hospitals, members and their families to plan and review medical necessity, intensity of services, level of care, length of stay and general appropriateness of care. Provides guidance to the provider network. Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care. May provide referrals for case management to member segments with chronic illness i.e., disease management, Quality Management and Appeals and Grievance Department.
Discharge planning for cases that exceed Extension of Authority or dx assigned to RN. Coordinates Care for Lower Level of Care coordination such as Skilled Nursing Facility, Home Health, Home Infusion, Rehab. Ability encompasses broad knowledge of concepts, practices and procedures required within health care field. Uses concepts and abilities as well as internal policies and procedures to complete assignments and solve problems Reviews cases for Continuity of Care and invest/exp requests
Current active unrestricted CA RN License.
Able to operate PC-based software programs including proficiency in Word and Excel.
Strong clinical documentation skills, independent problem identification and resolution skills.
At Wollborg Michelson, we are committed, tenacious, and passionate about what we do. Whether you' re a company trying to fill a position with a highly specific profile, or a candidate searching for the right opportunity to match your unique skillset, we know the challenges you face. More importantly, we have the expertise, experience, and drive to overcome them. We have been respected for decades, but earn our reputation every day.