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Telephonic Case Manager (Outpatient) - Registered Nurse (RN)

Job Description

Ambulatory Case Manager – Registered Nurse (RN)

  1. Responsible for the care management (coordination of outpatient care) of members with catastrophic illnesses and the chronically ill while ensuring that quality standards are met by using clinical judgment to evaluate and assess.
  2. Apply case management concepts, principles, and strategies to develop a Plan of Care (Care Plan) that addresses the member’s needs and limits patient hospitalization
  3. Telephonic assessments ensuring members receive all necessary care allowed under their benefit plan.  
  4. Review of medical records and/or other documentation to determine medical necessity, appropriateness and level of stay utilizing Milliman Care Guidelines
  5. Update PCP, healthcare providers, Medical Directors, health services staff and social workers regarding member’s status. 
  6. Assist in the identification and reporting of potential quality improvement issues. 

Job Requirements

  • One year Ambulatory Case Management, preferably in a Managed Care setting
  • Care coordination, outpatient services
  • Multi task in steady paced environment, smaller office setting
  • Milliman a plus


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, Insurance, Nurse
Education Not Specified
Experience At least 1 year(s)
Manages Others Not Specified
Industry Healthcare - Health Services, Insurance, Managed Care
Required Travel None
Job ID 21A*
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Telephonic Case Manager (Outpatient) - Registered Nurse (RN)

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