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Concurrent Review Nurse - RN I (Temporary)

Company: Central California Alliance for Health
Location: Salinas
Posted on: July 10, 2019

Job Description:

--
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 330,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here--or check out this video.--
This is a temporary position. The length of assignment is estimated from July 2019 to August 2019, but is always dependent on business need and dates may change.--
--
WHAT YOU'LL BE RESPONSIBLE FOR
Performing concurrent or post-service (retrospective) review of acute in-patient care services using established criteria and participating in Utilization Management (UM) Care Programs.--

WHAT YOU'LL NEED TO BE SUCCESSFUL


  • Knowledge of:

    • Utilization Management, and/or Case Management principles and practices
    • Medi-Cal and related policies and Title 22 regulations


    • Ability to:

      • Travel to Alliance-contracted acute, sub-acute, skilled-nursing and long-term care facilities to perform concurrent and/or retrospective review
      • Demonstrate strong critical thinking and problem solving skills
      • Navigate and evaluate electronic medical records and other health care data in order to determine the appropriate level of care
      • Give clear direction and sequence information verbally, so others can follow and understand
      • Exercise good judgment and tact in relating to contracting health care providers and beneficiaries.


      • Education and Experience:

        • Current, unrestricted California licensure as a Registered Nurse is required
        • Minimum three years of experience in an acute care setting, which included at least one year of experience in Utilization Management Case Management or similar health programs; or an equivalent combination which would provide the required knowledge, skills and abilities may be qualifying.



          --
          To read the full position description, and list of requirements--click here.

          At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for sponsorship.
          --

Keywords: Central California Alliance for Health, Salinas , Concurrent Review Nurse - RN I (Temporary), Healthcare , Salinas, California

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