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RN - Utilization Management

Rancho Cordova, California 95670 | Contract

Job ID: 56564 Position: Registered Nurse Branch: Rancho Cordova

RN JOB DESCRIPTION
  • 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 HCS 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
  • Support to senior/lead CMs as needed.

Required Skills: 

Generally requires moderate to thorough experience in nursing, health care or related field. (5 years)

Current active unrestricted CA RN License. Bachelor of Science in Nursing or advanced degree preferred.

Able to operate PC-based software programs including proficiency in Word and Excel. Strong clinical documentation skills, independent problem identification and resolution skills

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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