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RN or LVN Utilization Manager - 31688-1

San Francisco, California 94105 | Contract

Job ID: 56443 Position: Healthcare Branch: Rancho Cordova

  • 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, IPA/MGs, 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 case management to member segments with chronic or catastrophic illness.
  • Specific licensing requirements may apply depending upon position i.e. LVN, RN or Clinical Social Worker.
  • Discharge planning for cases that exceed EOA or dx assigned to RN.
  • Follow-up with LLC coordination such as SNF, HH, HI, Rehab.
  • Referrals to QM, DM, CM and AGD
  • IPA oversight, Continuity of Care, Healthy Families activities, OOA/OON cases, invest/exp, POS
  • Other CM activities as identified
  • Support to senior/lead CMs as needed. 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.

  • Generally requires moderate to thorough experience in nursing, health care or related field. (3-5 years)
  • Generally requires a Bachelors degree or equivalent and appropriate licensing.

Alana Klingman

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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