This job will have the following responsibilities:
The Medical Case Manager (LVN) (Concurrent Review) will be responsible for providing case management intervention on behalf of members with short term, stable and predictable courses of illnesses
Reviews requests for medical appropriateness.
Verifies and processes specialty referrals, diagnostic testing, outpatient procedures, home health care services and durable medical equipment and supplies via telephone or fax using established clinical protocols to determine medical necessity.
Screens requests for the Medical Director's review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director's decision and documents follow-ups in the utilization management system.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
The incumbent will be responsible for answering the medical appropriateness, quality and cost effectiveness of proposed hospital/medical/surgical services in accordance with established criteria.
Qualifications & Requirements:
Current, unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California required
High School diploma or equivalent required.
3 years of nursing experience required
1 year of Concurrent Review (in-patient) experience.
All qualified and interested candidates, please send your most updated resumes to edemey@judge.com for immediate consideration!
Contact: edemey@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
