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Health Plan RN Case Manager

Company: WPA Staffing Solutions, LLC
Location: San Diego
Posted on: November 10, 2018

Job Description:

Health Plan RN Case Manager Description Industry: Healthcare / Health Services - Managed Care Job Category: Medical / Health - Nurse The Case Manager is responsible for performing effective acute and ambulatory case management, utilization management and claims review activities to ensure appropriate, cost-effective care to Health Plan members, while always maintaining the highest quality of service. The Health Services team consists of Case Managers and Care Coordinators. Health Plans Medical Management department seeks to coordinate services for its members using a team approach to care. The following programs; case management, disease management, quality improvement and utilization management work together to ensure services are delivered appropriately and in the highest quality possible. The purpose of the Health Plan Utilization Management Program is to ensure medically necessary services are rendered at the appropriate level of care in a timely and cost-effective manner. Skills and Certifications [note: bold skills and certification are required] Does the candidate have an active, unencumbered RN license? (Yes) Does candidate have medical-surgical nursing experience? (yes) Does Candidate have 3 years of Utilization, Case Management or Quality experience? (yes) Does candidate have Health Plan experience? (yes) Compensation Full-time Benefits - Full Relocation Assistance Available - No Candidate Details 2+ to 5 years experience Management Experience Required - No Minimum Education - Associate's Degree Willingness to Travel - Occasionally Ideal Candidate Ideal candidate will be an RN experienced in Utilization Management/Case Management in the managed care setting with health plan experience. Ideal candidate is able to multi-task, is self-directed and can prioritize work load. Ideal candidate will have strong verbal and written communication and experience working with medical management products and programs. Any commercial health plan (regional or national) experience. Our greatest asset is our employees. We are working to be a High Reliability Organization and every employee from staff to leadership is vital to meeting that goal.

Keywords: WPA Staffing Solutions, LLC, San Diego , Health Plan RN Case Manager, Executive , San Diego, California

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