Providence Health & Services RN - Utilization Review - Case Manager in Mission Hills, California
Providence is calling a (Part Time/Day Shift) Utilization Review RN/Case Manager to our Facey Medical Foundation - Administrative Offices location in Mission Hills, CA.
In this position you will:
Be responsible for utilization review and discharge planning for capitated patients who are hospitalized.
Reviewing includes coordination of services for medical necessity, cost effectiveness, timelines of service and ensuring that quality standards are met.
Perform coordination of services for patients whose health plan has an at-risk agreement to ensure that services are medically necessary, cost effective, provided in a timely manner and meet local standards or care.
Required qualifications for this position include:
RN graduate of an accredited school of nursing.
Current California RN license
Current American Heart Association BLS for Health Care Providers required
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 preferred
Three to five years experience preferred in a managed care setting/utilization review/discharge planning/case management.
Strong clinical background preferably in acute care or home health.
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: Administrative Support (Clinical)
Location: California-Mission Hills
Req ID: 201406