Providence is calling a UR RN Case Manager ( Full Time / Day Shift ) to our Facey Case Management location in Santa Monica, 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 EPIC electronic EHR; employing web-based evidenced-based medical protocols.
Required qualifications for these positions:
RN graduate of an accredited school of nursing required.
Strong clinical background preferably in acute care or home health.
Current California RN license
American Heart Association BLS for Health Care Providers .
Must possess excellent customer service and communication skills.
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 these positions:
Three to five years experience in a managed care setting/utilization review/discharge planning/case management.
About the organization you will serve:
Facey is a Medical Group with offices in the San Fernando, Santa Clarita, Simi and San Gabriel Valleys. We are known as a multi specialty medical group, meaning we employ over 180 healthcare providers offering a broad range of specialties including primary care, OB/GYN and medical and surgical specialties. Facey operates two Urgent Care Centers (Santa Clarita & Mission Hills) that offer comprehensive physician services, lab and radiology seven days a week. We have affiliations with several hospitals in our service areas including Providence Holy Cross Medical Center, Providence St. Joseph Medical Center, Henry Mayo Newhall Medical Center, Northridge Medical Center, Simi Valley Medical Center and San Gabriel Medical Center. We are physicians who treat members of various insurance plans. Facey contracts with most of the major health insurance plans. We see HMO, PPO, Medicare, MediCal and cash pay patients. For those who are Medicare eligible, Facey not only takes Medicare but we contract with many of the Medicare Advantage Prescription Drug Plans (MAPD – HMO) as well as Medicare Supplement or MediGap PlansHigh School.
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.
Providence St. Joseph Health is a family of partner organizations including Providence Health & Services, St. Joseph Health, Facey Medical Foundation, Swedish, Pacific Medical Centers, Covenant Health and Kadlec. With 50 hospitals, more than 800 physician clinics, and a variety of health and educational services that include senior care and supportive housing, the health system and its partners em...ploy more than 100,000 caregivers (employees) serving communities across seven states: Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. PSJH’s family of organizations work together to meet the needs of its communities, especially the poor and vulnerable.