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Registered Nurse (RN) – loc reviews (InterQual) Case Manager

Job Description

Registered Nurse (RN) - Case Manager, Medical Center

  1. Responsible for the assessment, facilitation, planning and coordination of medical care and services for patients to ensure appropriate treatment in the most cost effective manner
  2. Level of Care, Length of Stay, Continued Stay Reviews
  3. Coordinating discharge planning with physicians, nursing, and social services, patient and family.
  4. Review patient procedures and DRG status against criteria for Medicare, Medi-Cal, and other insurance coverage.
  5. Coordinate chart reviews for quality reports and clinical procedures
  6. Perform chart reviews and quality assessments using severity of illness (SI) and intensity of service (IS) InterQual criteria (and/or Milliman)
  7. Using InterQual or Milliman criteria for medical necessity to determine if the patient is in the correct hospital setting and continued stay meets guidelines (S/I and I/S)
  8. Process TARS as needed

Job Requirements

About the Agency:
Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information!

Job Snapshot

Employment Type Full-Time
Job Type Health Care, Nurse
Education 2 Year Degree
Experience At least 2 year(s)
Manages Others No
Industry Managed Care, Healthcare - Health Services
Required Travel None
Job ID 28A*
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Registered Nurse (RN) – loc reviews (InterQual) Case Manager

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