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Inpatient RN Case Manager - $3000 SIGN-ON Bonus! Irvine, CA more...
Location:Irvine, CA
Company:OptumCare
First posted:April 17, 2017 (last updated 3 weeks 1 day ago)
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At Monarch HealthCare, an OptumCare Company, you will perform within an innovative culture focusing on transformational change in the health care system. You will leverage your skills across a diverse and multi - faceted business. Your contributions will have an impact greater than you have ever imagined! Join us and help people live healthier lives while doing your life's best work.(sm)

As a part of our continued growth, we are searching for an Inpatient Case Manager-Office based, with ability tocover on-site at hospitals.

Monday - Friday 8:00 AM - 5:00 PM

Primary Responsibilities:

Performs concurrent and retrospective onsite or telephonic clinical review at the designated network or out - of - network facilities as needed / directed by the ICPS Management team
Documenting medical necessity and appropriate level of care utilizing clinical guidelines (e.g. Milliman, Interqual). Complies with CMS regulations and Health Plan requirements
Interacts and effectively communicates with members, their families and / or designated member representative to assess discharge needs and formulate discharge plan, provide Health Plan benefit information, and services available based on clinical need
Efficiently navigates and utilizes computer data entry programs including, but not limited to: Microsoft Office (Outlook, Word, and Excel)
Provides guidance and benefits information for members and their families and facility discharge planners
Documents and maintains a Continuity Plan of Care for the Monarch HealthCare member by assessing and identifying continued needs upon discharge to encompass; health services, durable medical equipment, hospice, follow - up physician appointments, skilled versus sub - acute versus custodial levels of care
Issues the appropriate denial letters based on Health Plan or CMS guidelines utilizing ICE language

Required Qualifications:

Current unrestricted State California RN nursing license
2+ years of recent experience working inpatient hospital
1+ year of experience in utilization management
Efficiently navigate Microsoft Office (Word, Excel, Outlook)
Preferred Qualifications:

Bachelors Degree in Nursing
1+ year of experience in case management
1+ years of experience in managed care
CCM
What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining Optum and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: CCM, RN Case Manager, UM, Milliman, acute care, managed care, BSN, disease management, hospital, Irvine, Laguna Hills, CA

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