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Registered Nurse (RN) - Case Manager (InterQual) UR
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Job Description

Registered Nurse (RN) - Case Manager

  1. Responsible for assessing, planning, implementing, and evaluating the needs of patients for discharge planning and utilization review.
  2. 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
  3. 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)
  4. Level of care and length of care reviews
  5. Establishes treatment programs; coordinating services being provided
  6. Monitors cases by observing and evaluating treatments and responses
  7. Identify potential quality issues, delays in service, post-acute care needs
  8. Pre-certification and Prior Authorization.

Job Requirements

  • California Nursing License (RN)

 


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 Healthcare - Health Services, Managed Care
Required Travel Not Specified
Job ID 04A*
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Registered Nurse (RN) - Case Manager (InterQual) UR


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