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Transplant oncology nurse case manager

Innovation Technology

This is a Full-time position in Rancho Cordova, CA posted December 10, 2019.

Calabria Group is excited to offer multiple openings.

My Client Blue Shield is seeking Utilization Manager and Nurse Case Managers.

With Transplant Experience Max Pay Rate $50.00HR Contract and contract to hire positions.

You would be working with a Health Care Giant advancing your career.

If you are interested in learning more please reach out to me ASAP ncorp@calabriagroup.com.

OR 903-922-5044 Neil.

Working with complex cases promotes the delivery of quality; cost-effective health care services based on medical necessity and contractual benefits.

Works with other members of HCS team, providers, hospitals, IPA/MGs, members, and their families.

Responsible for prior authorizations, UM concurrent review meeting medical necessity, intensity of services, level of care, length of stay and general appropriateness of care.

Provides guidance to the provider network.

Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care.

May provide case management to member segments with chronic or catastrophic illness.

Specific licensing requirements for an RN applies.

Ability to function as above Prior authorization Transplant Experience UM Concurrent Review Discharge planning for cases that exceed EOA or dx assigned to RN.

Follow-up with LLC coordination such as SNF, HH, HI, Rehab.

Referrals to QM, DM, CM, and AGD IPA oversight, Continuity of Care, Healthy Families activities, OOA/OON cases, invest/exp, POS Other CM activities as identified Support to senior/lead CMs as needed.

Ability encompasses broad knowledge of concepts, practices, and procedures required within the health care field.

Uses concepts and abilities as well as internal policies and procedures to complete assignments and solve problems.

Generally requires moderate to thorough experience in nursing, health care, or related field.

(3-5 years) Generally requires a Bachelor’s degree or equivalent and appropriate licensing.