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Registered Nurse (RN) – Case Manager, Discharge Planner

Registered Nurse (RN) – Case Manager, Discharge Planner

Job Description

RN Case Manager

  • Concurrent Review, Level of Care, Severity of Illness (SI), Intensity of Service (IS) and Discharge planning
  • Using InterQual or Milliman criteria for medical necessity
  • Review patient procedures and DRG status against criteria for Medicare, Medi-Cal, and other insurance coverage.
  • Process TARS, treatment authorizations requests as needed
  • Coordinate chart reviews for quality reports and clinical procedures

Job Requirements

  1. DRG and ICD-9 and CPT coding, requirements for prior approval.

  2. Available community resources.

  3. Local Referral Network

  4. Effective charting practices and guidelines.

  5. Reimbursement related to Medicare, Medi-Cal & Managed Care

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, Professional Services, Nurse
Education 2 Year Degree
Experience At least 3 year(s)
Manages Others No
Industry Healthcare - Health Services
Required Travel Not Specified
Job ID 11A*
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Registered Nurse (RN) – Case Manager, Discharge Planner

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