Medical Case Manager - RN, LCSW, LPCC or LMFT

Kinetic Personnel Group is currently recruiting a Medical Case Manager (RN/LCSW/LPCC/LMFT) for a $3 billion-dollar a year government public health plan (government agency) is renowned for its work in the community and being a great place to work.

This position is a 6 month temporary position (in-office, onsite) in the city of Orange, that pays between $45/hr - $65/hr depending on experience. This will become a permanent position for the right candidate.

A full time permanent position includes a pay raise, telecommute options, a CalPERS Pension and excellent government benefits including generous holiday, PTO and sick pay days off, year one!

Job Duties

• Reviews requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request. 

• Mails rendered decision notifications to the provider and member, as applicable. 

• Screens inpatient and outpatient requests for the Medical Director’s review, gathers pertinent medical information prior to submission, follows up with the requester by communicating the Medical Director’s decision and documents follow-up in the utilization management system. 

• Completes the required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates. 

• Identifies and reports any complaints to the immediate supervisor utilizing the call tracking system or through verbal communication if the issue is of an urgent nature. 

• Refers cases of possible over/under utilization to the Medical Director for proper reporting. 

• Completes care coordination activities as related to Transition Care Management (TCM) activities. 

• Reviews International Classification of Diseases (ICD-10), Current Procedural Terminology (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and the existence of coverage specific to the line of business. 

Requirements:

Current California unrestricted license such as LCSW, LPCC, LMFT or RN and related required

3 years of clinical experience required

Utilization management reviewer experience required.

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