Providence Health & Services RN - Case Manager - UR Ambulatory in Mission Hills, California
Providence is calling a UR Ambulatory RN Case Manager (Full Time, Day shift) to our Facey Case Management location in Mission Hills, CA.
In this position you will:
Ambulatory Case Manager reviews ambulatory referrals on all capitated patients.
The referrals are evaluated for medical necessity using clinical guidelines.
Appropriate targets are selected using the Select Provider List, Contract information, and awareness of division of financial responsibility.
The case manager works closely with the UM Medical Director and UM Assistant Medical Director to ensure that decisions are consistent with guidelines.
The ambulatory nurse case manager prepares cases for weekly UM committee and Clinical Case reviews at several Facey sites.
Works closely with the Gerinet SNF team to deliver appropriate skilled care at the nursing home level.
Assists the UM Compliance Manager in preparing for health plan audits and ensuring that all referrals are evaluated within the appropriate time frames.
Is a resource to Facey physicians and Nurse Practitioners.
Required qualifications for this position include:
RN graduate of an accredited school of nursing.
Current California RN license.
American Heart Association BLS for Health Care Providers.
Must possess excellent customer service and communication skills.
Must be organized and a self‑starter, be able to utilize multiple resources to determine health plan requirements and benefits as applied to the utilization and case management process and clinical decision making.
Must have working understanding of MS Outlook, Word and Excel and be capable of being trained in referral processing software.
Preferred qualifications for this position include:
Bachelor’s degree in Nursing.
Three to five years experience as an RN Case Manager in a managed care setting/utilization review/discharge planning/case management.
Strong clinical background preferably in acute care or home health.
Bilingual Spanish speaking preferred.
About the organization you will serve:
Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago.
Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Location: California-Mission Hills
Req ID: 196483