Providence is calling a Utilization Review RN Case Manager for our PMI South Bay location.
In this position you will:
- Responsibleforutilizationreviewanddischargeplanningforcapitatedpatientswhoare hospitalized.
- Thereviewincludescoordinationofservicesformedical necessity,cost effectiveness,timelinesofserviceandensuringthatqualitystandardsaremet.
- Performscoordinationofservicesforpatientswhosehealthplanhasanat-riskagreementtoensurethat servicesaremedicallynecessary,costeffective,providedinatimelymannerandmeetlocal standardsorcare.
Required qualifications for this position include:
- RNgraduateofanaccredited schoolofnursing.
- Current California Registered Nurse License.
- AmericanHeartAssociationBLSforHealthCare Providers.
- Mustpossess excellentcustomerserviceandcommunicationskills.
- Mustbeorganizedandaself-starter,beabletoutilize multiple resourcestodeterminehealthplanrequirementsandbenefitsasappliedtotheutilizationandcase managementprocessandclinicaldecisionmaking.
Preferred qualifications for this position include:
- Bachelor's degree.
- Three tofiveyearsexperiencepreferredinamanagedcaresetting/utilizationreview/discharge planning/casemanagement.
- Strongclinicalbackgroundpreferablyin acutecare.
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 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
Req ID: 143542