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Company Contact Info
- Corona, CA
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The Judge Group • Corona, CA
Posted 21 days ago
Experience - 2 to 4 years
Degree - 4 Year Degree
Other Great Industries
Health Care, Management
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One of our best clients is seeking Case Manager in California.
This position is located in Corona, CA.
Generic Job Description:
- Educates providers, employers and employees and sets appropriate expectations
- Verifies STD coverage and manages claims according to the specific contractual provisions of the client
- Independently manages a claims caseload to ensure client requirements are achieved and internal policy and procedure requirements are met
- Communicates claim determinations with members and provides them direction on appeal process, when applicable
- Evaluates clinical information including non-clinical barriers to form a comprehensive claim decision with a strategic action plan
- Negotiates and communicates with employers to identify opportunities for accommodations within the workplace for a safe and timely return to work
- Leverages critical thinking, extensive clinical knowledge, experience and skills in a collaborative process to develop a comprehensive strategy for the member to reach a higher level of function and/or return to work.
- Consults and reviews clinical information and utilizes appropriate industry-standard tools, policy procedure and clinical judgment to provide a strategic plan of management
- Completes medical reviews considering specific contractual provisions as applicable
- Independently identifies complex situations where communication with internal and/or external providers is needed to reach a full understanding of the factors involved with the assessment of capacity and function.
The following qualifications must be met to be considered for this opportunity:
- AA, Bachelor's Degree, or equivalent from four year college or technical school.
- RN or LVN with current California license.
- 2 to 4 years clinical experience in acute care (i.e., ICU,CCU, ER, med-surg) or related health care experience.
- 1 year managed care experience
- Computer literate in Microsoft Word
Please send your MOST UP TO DATE resume to Laura at [Click Here to Email Your Resumé]
Job ID: 543671
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