Providence Health & Services RN - Utilization Review Case Manager in Torrance, California
Providence is calling a Utilization Review RN Case Manager ( Full Time / Day Shift ) at our Providence Medical Institute Axminster Managed Care location in Torrance, CA.
In this position you will:
Be responsible for utilization review and discharge planning for capitated patients who are hospitalized.
Coordinate 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:
Current California Registered Nurse License.
Strong clinical background preferably in an acute care or home health
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:
Three tofiveyearsexperiencepreferredinamanagedcaresetting/utilizationreview/discharge planning/casemanagement.
Strongclinicalbackgroundpreferablyin acute care or home health
About the Providence Medical Institute you will serve.
Providence Health & Services Southern California is further developing its physician integration strategy. Historically, the largest asset has been Providence Medical Institute, a medical foundation that provides administrative and other support services to affiliated medical groups. Providence Medical Institute is expected to grow significantly in the next several years, bringing with it facilities, staff and physician growth to support that objective.
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
Req ID: 224038