Providence is calling a Complex Case Manager RN ( Full Time / Day Shift ) at our Providence Medical Institute Axminster Managed Care location in Mission Hills, CA.
In this position you will:
- Complex Case Manager assists in the coordination of care and services provided to members who have experienced a critical event or diagnosis. The goal of the complex care management case manager is to help patients regain optimum health or improved functional capability, in the right settings, and to ensure that services are medically necessary, cost effective, provided in a timely manner and meet local standards or care. This is an office-based position located in the Utilization Management Department in Mission Hills, California. It involves telephonic outreach to perform comprehensive assessments of the patient's condition, determination of available benefits and resources, and development and implementation of a care management plan with performance goals, monitoring and follow up. Documentation of all patient care and encounters will be in an electronic format in the CCM software and Facey's electronic EHR; employing web-based evidenced-based medical protocols
Required qualifications for this position include:
- Bachelor's required.
- California State Registered Nurse License.
- Two to three year's acute hospital experience, including one year of supervisory experience.
- Strong leadership, supervision interpersonal and organizational skills.
- Excellent communication skills, both oral and written.
- Ability to plan, organize, prioritize, evaluate and document.
- Basic computer skills, Word, Excel, Access and PowerPoint.
- Knowledge regarding State and Federal regulations, HMO, PPO and Utilization processes.
- Knowledge of Discharge planning and Case Management.
- Knowledge of principles and practices of Utilization and Quality Management.
- Knowledge of CPT, IDC-9 Coding.
Preferred qualifications for this position include:
- Masters in health care related field preferred.
- Spanish Bilingual
About the location 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 people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. 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: 148809