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  • Corona, CA

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Case Manager|Hourly

The Judge Group • Corona, CA

Posted 21 days ago

Job Snapshot

Experience - 2 to 4 years
Degree - 4 Year Degree
Other Great Industries
Health Care, Management


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Job Description

Case Manager

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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