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Inpatient Case Manager

Purpose: (One sentence summary of the job function.)In general, the Inpatient Case Manager is obligated to maintain and constantly evaluate the appropriateness of a member/patient level of care, to maintain the efficiency and integrity of the referral process, and to monitor the quality of outcomes. This position consistently supports compliance and the Principles of Responsibility (Kaiser Permanente´s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente´s policies and procedures. In addition, Regional leaders are accountable for communication, implementation, enforcement, monitoring and oversight of compliance policies and practices in their departments. Accountabilities: (List of 4--6 primary responsibilities, not activities, in their order of importance)1. Maintain the data integrity and authorization process of the Referral Management System (RMS).1.1 Maintain attention to detail and accuracy to optimize the quality of data provided to internal and external customers,1.2 Schedule and plan work while being sensitive to time constraints and resource2. Judiciously conserve Health Plan resources.2.1 Clarify eligibility status in accordance with Health Plan policies and procedures.2.2 Ensure the appropriate administration of benefits by accurate interpretation and by applying the benefit within limitations, and in a manner that exhibits judgment and a realistic understanding of issues.2.3 Identify issues, trends, and barriers that delay the patient´s timely transition to the next level of care, and accurately communicate this information to others regardless of their status or position.2.4 Take independent clinical decisions for resource allocation within departmental2.5 Influence actions and opinions in cases where a physician need assistance to expeditiously transition a patient to the most appropriate level of care.2.6 Maturely express opinions and use negotiation skills to influence financial outcomes related to hospital days, alternative care and other referred services.3. Provide case management services.3.1 Utilize the nursing process approach to prospectively and concurrently formulate and execute plans for health care services in collaboration with MAPMG and community physicians.3.2 Identify where -- support structures exist, identify appropriate referrals and resources and take action and make commitments to solve individual patient care management problems.3.3 Assess and monitor the plan of care and deal with unresolved situations or unexpected events.3.4 Develop creative patient care alternatives to ensure the delivery of high quality, cost effective care using analytical problem solving as well as intuition to stimulate new waves of thinking.3.5 Discuss complex or difficult individual cases with the Manager of Referral Operations, MAPMG physicians and QRM physicians.3.6 Participate in discharge planning.4. Provide utilization management services.4.1 Consistently apply approved utilization review guidelines for services delivered in acute or alternative settings and be able to prioritize objectives.4.2 Monitor medical necessity for acute care and initiate denial process according to ORM policy where indicated,4.3 Focus utilization review activities on targeted areas as identified by the QRM department and modify work activities accordingly.4.4 Provide case finding/screening services and refer patients who need case management services to appropriate staff.4.5 Exhibit effective, mature problem solving behavior even when dealing with interpersonal conflict, emotional issues or in the face of juggling multiple demands and priorities.4.6 Demonstrate persistence in problem solving using a reasoned, realistic approach while showing motivation and a sense of urgency.4.7 Discuss complex or difficult individual cases with Manager of Referral Operations, MAPMG physician managers and QRM physicians.5. Provide quality screening.5.1 Demonstrate competency to assess all aspects of care across the continuum for variations from quality and utilization standards.5.2 Conduct concurrent reviews of specific conditions or procedures as directed and communicate results5.3 Seek clarification of incomplete or illegible records including inpatient, outpatient and contracting physician office records and report problems for corrective action.5.4 Identify and report potential risk cases or situations by presenting clear information that builds credibility.5.5 Exhibit a commitment to the continual improvement in the quality of patient care services.6. Demonstrate competency to respect patient rights.6.1 Display an awareness of individual rights of patients and educate the member about those rights.6.2 Maintain confidentiality of patient records, information, and departmental activities involving patient information.6.3 Practice within ethical and legal guidelines using established policies and procedures for guidance.7. Coordinate communication and promote collaboration between the disciplines providing care or case management within and outside the Kaiser Permanente system.7.1 Optimize productive working relationships by functioning as a liaison, problem solver, and consultant for community social services, health care agencies, providers and various Kaiser Permanente departments.7.2 Provide case management, utilization and referral management, and benefit interpretation for attending physicians, service chiefs, area physician managers, and medical facility managers.7.3 Work with Medical Center staff and physicians to develop appropriate plans of care for individual patients or groups of patients in such a way as to build high morale and group commitment to goals and objectives.8. Demonstrate competency to perform as a team member.8.1 Collaborate with other QRM staff by assisting with routine department functions in a helpful manner.8.2 Seek managerial guidance prospectively in cases with high cost potential where benefit management is an alternative, when quality or utilization issues will have a financial impact on Kaiser Permanente or when issues need resolution or clarification.8.3 Train and orient assigned personnel and alert manager to difficulties or situations that require the manager´s personal attention.8.4 Participate in departmental activities related to education, staff meetings, and guideline and policy development.8.5 Demonstrate flexibility based on the overall needs of the department.

Department: Patient Care Services Coordination of CareSchedule: On-call, Regular, 00 hours per week, 07:30 - 16:00 (May include weekends, evenings and after hours. Based On Departmental Needs.)Position Summary: Please be aware that this position is currently under review as part of the jurisdictional process with the California Nurses Association to determine whether such position should be assigned to the CNA bargaining unit. This review is on a position-by-position basis and includes an analysis of the actual duties performed in each position under review. This determination will be made within the next several months. Should the determination be made that the position does belong to the CNA bargaining unit, you will be offered the opportunity to (a) follow the work into the CNA bargaining unit and become a member of the union, or (b) seek other employment within the organization. Should you have any questions regarding this notice, please contact your recruiter for further information. Coordinates with physicians, staff, and non-Kaiser providers and facilities regarding patient care. In conjunction with physicians, develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and develops guidelines for care. Performs utilization management activities, discharge planning, and care coordination across the continuum of care in collaboration with the physician and other members of the health care team.Education/License/Certification: Bachelors degree, or equivalent experience, in nursing or health related field. Masters degree preferred. Graduate of an accredited school of nursing. Current California RN license required.PREFERRED Education/License/Certification: BSN or BA in health care related field or Diploma/Associate Degree Nursing (ADN) with comparable years of experience required. Masters Degree preferred. Graduate of accredited school of nursing. Current California RN licensure required, BLS Certification Qualifications: Previous case management experience preferred. Demonstrated experience in utilization management, discharge planning, or transfer coordination. Knowledge of Nurse Practice Act, The Joint Commission and other federal/state/local regulations.PREFERRED Qualifications: Experience (usually 2+ years) in direct patient care delivery or and management. Demonstrated experience in utilization review, case management, and discharge planning preferred (usually 2+years). Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA and all other applicable federal/state/local laws and regulations. Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgment abilities. Fundamental word processing and computer navigation skills and the ability to interpret and use analytic data in day to day operations. Knowledge of healthcare benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).Duties: Plans, develops, assesses, and evaluates care provided to members. In conjunction with physicians, evaluates and develops discharge plans, recommends alternative levels of care, and ensure compliance with federal, state, and local requirements. Develops and maintains case management policies and procedures. Coordinates, directs, and performs concurrent and retrospective reviews,and monitors level and quality of care. Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families. Consults with physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization. Encourages members to follow plans of care (e.g., drug therapy, physical therapy). Makes referrals to appropriate community services. Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum. Develops and collects data, and trends utilization of health care resources. Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff,contract providers, and outside agencies. Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.OTHER Duties: Utilization Management Performs daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately. Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives. Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care). Discharge Planning Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies. Performance Improvement Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols. Participates in the development and implementation of guidelines, preprinted physician orders, care paths, etc. For patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-daystays, DRGs, LOS, etc. Participates in the development, implementation, communication, maintenance and monitoring of local UM Workplan initiatives. Administrative and Regulatory Shares accountability with the UM Manager for planning, developing, and managing the department budget. Participates in interviewing, makes hiring recommendations, orients and provides on-going supervision of support staff. Provides input into the performance evaluations of team members. May plan and control work assignments and special projects of team members. Assists in developing, implementing and maintaining utilization management policies and procedures. Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements (see qualifications). Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente�s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente�s policies and procedures.

Patient Care Coordinator Opportunity!

This position supports Kaiser Permanente´s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures.Kaiser Permanente is proud to be an equal opportunity/affirmative action employer.DEPARTMENT: Continuing CareSCHEDULE: On-call, 00 hrs/week, Day shift, Sunday - Saturday, 8:00am to 5:00pm.EDUCATION/LICENSE/CERTIFICATION: BSN or BA in health care related field or Diploma/Associate Degree Nursing (ADN) with comparable years of experience required. Masters Degree preferred. Graduate of accredited school of nursing, BLS Certification, and current California RN licensure required.JOB SUMMARY: Performs utilization management activities, discharge planning, and care coordination across the continuum of care in collaboration with the physician and other members of the healthcare team.QUALIFICATIONS: Experience (usually 2+ years) in direct patient care delivery and management.Demonstrated experience in utilization review, case management, and discharge planning preferred(usually 2+ years). Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA,HIPPA, ERISA, EMTALA and all other applicable federal/state/local laws and regulations. Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgment abilities. Fundamental word processing and computer navigation skills, and the ability to interpret and use analytic data in day to day operations. Knowledge of healthcare benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).DUTIES: Utilization Management: Performs daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately.Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives.Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care).Discharge Planning: Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing , social services, and other healthcare providers and agencies.Performance Improvement: Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols.Participates in the development and implementation of guidelines, preprinted physician orders, care paths, etc. for patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-day stays, DRGs, LOS, etc. Participates in the development, implementation, communication, maintenance and monitoring of local UM Work plan initiatives.PLEASE NOTE: - Kaiser Permanente is an AA/EEO employer -

Spectrum Healthcare Resources has an opportunity for a permanent, civilian RN Discharge Planner at Wilford Hall Medical Center at Lackland AFB in San Antonio, TXDetails:* Monday-Friday 7:30-4:30 p.m. * Excellent Compensation and Benefits * Up to 3 Weeks Paid Time Off * 10 Paid Holidays * Supportive Team Environment Requirements:* 6 yrs broad based nursing experience * Current, unrestricted RN license in state of TX * BLS required Company Overview: Established in 1988, Spectrum Healthcare Resources (SHR) has earned a solid reputation in the health care industry.  SHR is JCAHO certified and dedicates itself exclusively to supplying a broad spectrum of medical professionals, LPNs, CNAs, Registered Nurses, Nurse Practitioners, Physician Assistants and Physicians, for Military Treatment Facilities (MTF) located in the United States.  These permanent civilian contracted medical professionals experience a unique medical environment, working among the very best medical professionals, and caring for our military family.

Patient Care Coordinator/Case Mgr Opportunity!

This position supports Kaiser Permanente’s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures.Kaiser Permanente is proud to be an equal opportunity/affirmative action employer.DEPARTMENT: Utilization ManagementSCHEDULE: Part-time regular, 24 hours per week, Day shift, Monday through Wednesday: 8:30-5:00.Schedule dependant upon departmental needs. Requires weekend rotation every other weekend, 48 hours per pay period.Position Summary: Performs utilization management activities, discharge planning, and care coordination across the continuum of care in collaboration with the physician and other members of the health care team.Education/License/Certification: BSN or BA in health care related field or Diploma/Associate Degree Nursing (ADN) with comparable years of experience required. Masters Degree preferred. Graduate of accredited school of nursing, BLS Certification, and current California RN licensure required.Qualifications: Experience (usually 2+ years) in direct patient care delivery and management.Demonstrated experience in utilization review, case management, and discharge planning preferred(usually 2+ years). Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA,HIPPA, ERISA, EMTALA and all other applicable federal/state/local laws and regulations. Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgement abilities. Fundamental word processing and computer navigation skills, and the ability to interpret and use analytic data in day to day operations. Knowledge of healthcare benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).Duties: Utilization Management : Performs daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately. Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives.Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care).Discharge Planning: Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing , social services, and other healthcare providers and agencies.Performance Improvement: Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols.Participates in the development and implementation of guidelines, preprinted physician orders, care paths, etc. for patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-day stays, DRGs, LOS, etc. Participates in the development, implementation, communication, maintenance and monitoring of local UM Work plan initiatives.Administrative and Regulatory: Shares accountability with the UM Manager for planning, developing, and managing the department budget. Participates in interviewing, makes hiring recommendations, orients and provides on-going supervision of support staff. Provides input into the performance evaluations of team members. May plan and control work assignments and special projects of team members. Assists in developing, implementing and maintaining utilization management policies and procedures. Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements (see qualifications).Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.Consistently supports compliance and the Principles of Responsibility (KP’s code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures.In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.PLEASE NOTE: - Kaiser Permanente is an AA/EEO employer -

Since 1925, Sarasota Memorial Health Care System has grown to become the second largest acute care public hospital in Florida. Our 806-bed regional medical center is consistently recognized for our centers of excellence, patient safety as well as our employee satisfaction. As our community has grown, we have remained committed to investing in the latest technology and services. Currently, we are seeking an experiencedClinical Case Manager II12 hour Shifts: 11am-11pmThroughout our community, we have built a reputation for excellent patient care and a supportive team environment. To ensure the continuation of this tradition, we are currently seeking an experienced Clinical Case Manager II for our 20 bed medical observation unit. As a vital part of the patient care team, the Clinical CM must be comfortable and assertive dealing with physicians, nurse practitioners and staff members at all levels while fostering a solid team atmosphere. This position requires extremely strong clinical knowledge and the ability to interact and present the various options and plans to patients and their families.In this role, the Clinical Case Manager Level II (Clinical CM II) will utilize their professional nursing skills to assess patient and family scenarios for clinical appropriateness for the setting and establish plans for effective management of the continuum of care (episodic and population-based) with an overall observation LOS goal of 18 hours or less. The candidate will also be required to precept new staff and peers in effective application of Milliman USA and Interqual guidelines, develop department and organization-wide program to address issues relating to managing and improving the quality of care, utilization, cost and patient satisfaction. JOB QUALIFICATIONS:1. Graduate of an accredited school of nursing with a current Florida license.2. Masters degree preferred, Bachelors Degree required. Diploma or Associates Degree in Nursing and Case management Certification (CCM, ACM, CPHQ, ABQUAURP) required or BSN or Bachelors degree in health care administration or relevant health care area of study. The director must approve any variation in these requirements.3. Minimum of five (5) years of clinical practice in acute care hospital.4. Strong MedSurg background required (Cardiac experience preferred) 5.At least one year of Utilization Review, Interqual and Milliman and/or Case Management experience required.6. One year experience in SMH ICM as level I Case Manager prior to applying to Level II position, as full time employee. 7. Basic experience using PC (computer) required (word processing minimum); Use of Internet preferred, including e-mail and calendar; previous experience with hospital information systems (order entry, results reporting) preferred.8. Must meet all standards on Level I CM job description and exceed in selected standards. See level II application.* These may be waived for external candidates with comparable experience and skills.Located just minutes south of the Tampa Bay area, SMH is ideally situated on Florida´s west coast minutes from beautiful white, sandy gulf beaches. With an abundance of sunshine and outdoor activities, our location offers an array of activities for all lifestyles. From our affordable housing, close proximity to theme parks, golf courses, top universities and schools, world-class cultural activities, you will soon discover the attraction to Sarasota and our state-of-the-art magnet hospital!We encourage you to learn more about our facility, awards and opportunities or apply for the above position by visiting us online at www.smh.com

Our Care Coordination Department uses the triad model of an RN, MSW, and U.M. nurse specialist covering all patient areas.

Our Care Coordination Department uses the triad model of an RN, MSW, and U.M. nurse specialist covering all patient areas. This team is responsible for patient throughput, including, but not limited to: discharge planning; community resources utilization for patients; transfers - acute care nationwide and international, nursing home, home, and so forth; working with insurance companies; partnering with nursing staff, rehab, the patient/family and physician for effective and efficient delivery of care utilizing the patients available resources.The Care Coordination RN is responsible for coordinating the health care plan for an assigned patient population through the use of plans of care, clinical pathways, managed care guidelines, utilization review processes, performance improvement projects, and collaboration with all members of the health care team. Evaluates care, utilizing clinical skills based on quality, cost effectiveness, best practice and appropriate level of care standards. Maintains the continuum of care through the coordination and integration of all phases of patient care. Demonstrates unit/ area clinical designated competencies for all ages of the assigned unit.Education Required: Associates Degree. Must be licensed as an RN in Arizona Education Preferred: BSN Preferred or Bachelor´s degree in a health related field Experience Required: -5 Years clinical nursing experience in an acute care setting. -Computer literate Experience Preferred: -2 years Case Management in an Acute Care Setting -Experience with Interqual -Certification as a Case Manager (CCM, CPUT, or CMAC)

Our Case Management Department uses the Clinical Case Management model including an RN and MSW coverage for all patient areas.This team is responsible for patient throughput, including, but not limited to: discharge planning; community resources utilization for patients; transfers - acute care nationwide and international, nursing home, home, and so forth; working with insurance companies; partnering with nursing staff, rehab, the patient/family and physician for effective and efficient delivery of care utilizing the patients available resources.The Core Measures RN reports to the Case Management Director and is responsible for collaborating with physicians, case managers, and unit based nursing staff to provide concurrent review on specific clinical populations. The role ensures that documentation for these populations achieve Medicare requirements prior to discharge of the patient.Education Required: Education Required: Associates Degree. Must be licensed as an RN in Arizona, Education Preferred:BSNComprehensive knowledge of CMS requirements for Core Measures, Data abstraction, and documentation.Experience Required: 3 years of acute clinical care nursing experience Experience Preferred: 5+ years of acute clinical care nursing experience

Become a Cedars-Sinai Employee!

Hours: 7:30am - 4pm Days: Monday - FridayShift Type: DayWeekends: As Needed Job Description: Cedars-Sinai Medical Center, a 977-bed, Level I Trauma Center located near Beverly Hills, has exceptional case management opportunities available. Within our world-class teaching facility, you will make a significant contribution to the kind of nursing care that has repeatedly garnered us Magnet designation.Wee seeking dynamic individuals who would like to use their strong bedside background to play an even more active role in successful patient outcomes. Partnering with Masters-prepared Clinical Social Workers, you will assess patient cases in order to facilitate and drive the progression of their care.These positions require current CA RN licensure and recent clinical experience in inpatient acute care and case management. You must be passionate about patient involvement and motivated by leading an interdisciplinary care team. Case management certification is desired. Education and Work Experience Preferences: CA RN license required. Recent clinical experience, Inpatient Acute Care, Case Management and certification in case management preferred. Computer skills, excellent verbal, written communication skills required. Knowledge of medical literature, research methodology, health care delivery systems and financial reimbursement.Physical Demands:able to walk, stand for long periods of time.

RN, Referral Intake Specialist/Intake NurseClient Services has an immediate opening for a Registered Nurse with case management, intake, telephonic triage or comparable experience. The Client Services Referral Specialist/Intake Nurse is an integral member of the team and functions to serve as a single entry/easy access point serving to minimize barriers to health care through service coordination to include, handling all phases of the intake referral process, and facilitating tertiary referrals from inception to completion.CA RN license required. A minimum of two years experience working/interacting with HMOs, PPOs, health systems or third party risk sharers in the Southern California healthcare market is essential. Prior experience in Utilization Review, Case Management or Intake and exceptional customer service skills are a must.