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RN Case Manager

The Judge Group Sacramento Full-Time
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The Judge Group is looking for 8 RN Case Managers in Sacramento, Ca! 

This job will have the following responsibilities: 
  • Coordinate with the appropriate managers on a daily basis to assess the inpatient census for appropriate alternative health care service needs.
  • Utilizes pre-approved criteria and guidelines to validate medical necessity of continued stay and appropriateness of treatment and discharge planning (e.g. Milliman Care Guidelines, Interqual).
  • Performs on-site and/or telephonic concurrent review of acute and sub-acute services, as well as precertification review for all services following the plans authorization guidelines.
  • Predicts and plans for patient's needs from pre-admission, through acute and sub-acute care and post-discharge, in collaboration with the member and providers.
  • Coordinates with appropriate discharge planning with interdisciplinary health care team to coordinate timely discharge.
  • Participates in rounds with the Medical Director.
  • Participates in a regular rotation of after hours on call.
  • Monitors and facilitates appropriate utilization of resources using clinical criteria.

Qualifications & Requirements:
  • Degree in Nursing
  • Must be a Registered Nurse
  • Current unrestricted New Mexico Registered Nurse license
  • Must be able to complete a fingerprint background check
  • 3-5 years of utilization management experience nursing experience
  • 3-5 years of clinical hospital/acute care Proficiency in medical management software utilized for utilization review, medical appeals, and case management.
  • Medicaid and Medicare experience a must.
Please send your most up to date resume to Jaclyn at Email blocked - click to apply
 

Skills required

Electronic Medical Record
Disease Management
Hospitalization
Psychology
Long Term Care
Registered Nurse

Location

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RN Case Manager
Estimated Salary: $85K
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Job ID: 595653

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The Judge Group is a privately owned, leading professional services firm with nearly 50 years of experience in providing technology, talent, and learning solutions. Our services are successfully delivered through a network of more than 35 offices in the United States, Canada, and India. The Judge Group serves more than 47 Fortune 100 companies and is responsible for 7,000 professionals on assignment annually across a wide range of industries.

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