(Archived) Medical Management Specialist- RN

Position: Medical Management Specialist- RN
Location: Long Beach, CA
Shift: Full-time

Job Info

• Ensure that clinically appropriate inpatient and outpatient care and other services are rendered to SCAN members at the right time, at the right level of care and at the right location by co-managing complex medical and behavioral health cases, with provider organization case management and utilization management staff.52
• Manage complex medical cases by applying the essential activities of case management and utilization management including independent and autonomous member/caregiver assessment, planning, implementation, coordination, advocating, monitoring and evaluation.
• Assist members who require urgent and emergent medical and behavioral health services while outside the SCAN service area, by working directly with members, caregivers, and providers to ensure the provision of quality, coordinated care.
• Facilitate safe and effective discharges from inpatient settings by communicating member needs and issues identified during the course of inpatient treatment to other members of the care team including but not limited to SCAN Care Management staff, medical group case managers, and Primary Care Physicians (PCPs).
• Utilize department desktop procedures, workflows, job aids and training material. Identify barriers to work processes and brings to the attention of the supervisor/manager.
• Build effective professional relationships with providers and other internal and external partners utilizing verbal and written communication skills, developing trust, meeting timelines, respecting cultural differences, using active listening skills, and maintaining confidentiality.
• Provide insight into the management of chronic conditions to providers and hospitals. Assist providers to support members/caregivers with end of life planning by providing information, education and referral sources related to advanced care planning.
• Apply evidence-based criteria and guidelines to assess treatment plan, consulting with a SCAN Medical Director when needed and offer recommendations to the care team for medical and/or behavioral health management at the appropriate level of care.

Requirements

• Bachelor's Degree in Nursing
• 3+ years clinical experience with geriatrc population (Acute, Ambulatory care, SNF and/or LTC.
• Medicare/Medi-Cal experince in managed care environment
• 2+ years of case management experience in a medical group, IPA and/or HMO setting preferred
• Case Management Cerification (CCM), Accredited Case Management (ACM) or Cerified Professional of Utilization Management (CPUM) preferred
• Bilingual ability strongly preferred
• Basic knowledge of related NCQA standards, CMS and DHCS regulations

Benefits

• Competitive salary commensurate with experience
• Medical/Dental
• Weekly Pay
• Direct Deposit
• Referral Bonuses
• Childcare reimbursement

For immediate consideration please create a profile and submit your resume through our applicant tracking system. Applications with attached resumes will be given first consideration. Visit us online at [Register to View] to learn more about our company and to view additional openings in your area.

About Us: All Medical Personnel is a national leader in healthcare staffing and recognized by Staffing Industry Analysts (SIA) as one of the nation's largest healthcare staffing firms. Our team of seasoned recruiters are experienced in their ability to recruit, screen and place medical professionals for all types of healthcare settings.