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Utilization Management - Regis...

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Job Summary

Company
Managed Care Resources (MCR)
Location
Los Angeles, CA
Industries
Insurance
Healthcare Services
Job Type
Full Time
Employee
Years of Experience
2+ to 5 Years
Education Level
Associate Degree
Career Level
Experienced (Non-Manager)
Contact Information
Managed Care Resources (MCR)
Phone:  310-470-4232
Fax:  310-475-4737

Utilization Management - Registered Nurse (RN), UM Case Manager

About the Job

  1. Case Manager
  2. Registered Nurse (RN)
  3. Full Time, 40 Hours Per Week

 

About the Job:

  • Concurrent review and analysis of inpatient records to determine if the patient's admission and continued hospital stay triggers any pre-defined quality indicators.
  • Utilization review including assessment of medical records for appropriateness, level of care provided. 
  • Assess utilization of treatment, modalities, medications, services and application of treatment protocols.
  • Coordinate chart reviews for quality reports and clinical procedures

Requirements:
  • California Nursing License (RN)

    • At Least Two Years of Recent Acute Case Management Experience
  • Knowledge of:
    • DRG and ICD-9 and CPT coding, requirements for prior approval.
    • Available community resources. Local referral network
    • JCAHO Standards and Title XXII Regulations
    • InterQual or Milliman criteria experience a plus





About the Agency:

Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information!

 

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