Hours: M-F 8a-5p PST
Pay: $40-42/hour based on experience
Duties
• Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. (Prior authorization assignment)
• Review clinical information for concurrent reviews, extending the Length of Stay for inpatients as appropriate. (Concurrent stay review assignment)
• Assist hospital staff in facilitating timely discharges to home and/or other levels of care. (Discharge Planning assignment)
• Proactively identify members whose physical, mental and social circumstances present a barrier to safe hospital discharge.
• Review member grievances and determine classification as clinical or administrative. (Grievance and appeals assignment)
Requirements
• Valid California Registered Nurse license
• Bachelor's Degree (four-year college or technical school) Field of Study: Nursing, Healthcare, Case Management
• Case management and/or utilization review experience
• Knowledge of Medicare, Medi-Cal and related policy and regulations
#INDAR
Pay: $40.00 - $45.00 per hour
Benefits:
• Dental insurance
• Health insurance
• Vision insurance
Work Location: Remote