한국어/영어 bilingual 간호사 (LVN or RN)를 찾습니다.

Resume to info@a2zreturnvalues.com ( with expected salary )

Job Summary

Reports to Director of Medical Management, is responsible for overseeing the daily operations of the Care Management process to ensure quality patient care and appropriate utilization of care resources are within the parameters of health plan benefits and established contacts. The Outpatient Case Manager is part of the Medical Management team that is responsible for the clinical, quality, financial and patient outcomes for the outpatient Case Management and Inpatient Case Management team.

Responsibilities and Duties

· Works closely with the Medical Reviewers to ensure appropriate criteria is used when making medical decisions regarding denials. Also oversees Inpatient and Outpatient admissions/discharge planning and process on a daily basis.

· Ensures appropriate UR and CM processes are in place to maintain compliance with the regulatory bodies and established turnaround times.

· Ensures all reports, logos, etc. are sent in a timely manner to the Director of Medical Management for compliance with HP requirements.

· Must be responsible for the log maintenance, tracking and follow up.

· Must be able to participate in the development and implantation of CM Programs and policies and procedures and ensures that AMM stays consistent and compliant.

· Will monitor and analyze CM reports and identify trends, can make recommendations, and develop programs as well as interventions to improve department efficiency.

· Will assure contracted providers are used and will collaborate with the Contracting Department to obtain new contracts for specialty and ancillary services.

· Must identify, develop and oversee the educational needs of the care management staff and will motivate the CM staff in setting and reaching goals for improvement.

· Will work cooperatively with the Medical Directors, Executive Team and Director of Medical Management to present reports when requested.

Qualifications and Skills

· Must be a Licensed RN or LVN

· Five years or more experience in managed care environment, preferred.

· Three years management experience.

· BA or BS Degree preferred.

· Computer skills and proficient with Microsoft applications.

· Excellent verbal and written communication skills and must know medical terminology.

· Ability to work with minimal supervision and be highly organized and able to supervise others.

· Must be able to work independently and be highly organized while maintain strict confidentiality of all patient information and IPA business.