Judge Healthcare is currently seeking a Case Manager LVN (Concurrent Review) in Orange, CA!!
You will be responsible for providing case management intervention on behalf of members with short term, stable and predictable courses of illnesses.
You would also be responsible for answering the medical appropriateness, quality and cost effectiveness of proposed hospital / medical / surgical services in accordance with established criteria.
Responsibilities :
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals / priorities for the department.
- Reviews and evaluates proposed services utilizing medical criteria and / or established policies and procedures. This includes review of submitted medical documentation and / or photographs.
- Determines the appropriate action regarding the service being requested for approval, modification, or denial, and refer to the Medical Director for review when necessary.
- Determines if the inpatient setting requested for surgery and / or medical care is appropriate. Identifies diagnosis and determine need for continuing hospitalizations
Qualifications & Requirements :
- HS Diploma required
- Current CA LVN licensed required.
- 3+ years clinical experience with 1+ year in managed care setting.
- 1+ year concurrent review experience preferred.
- Bilingual is a plus!
If this would be of interest to you or someone you might know, please apply by clicking on the link on the job posting. If you would like more information or have any questions, please reach out to Jacob at [email protected]
Thank You,
Jacob
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