Cedars-Sinai Case Manager - LVN in Beverly Hills, California
Job Posting: UM/Medical Management Clinical Nurse is responsible for working with the interdisciplinary care teams to ensure appropriate and consistent administration of plan benefits to pre and/or retro authorize services, assess medical necessity and appropriateness of treatment setting by applying appropriate medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure. The UM/MM Clinical Nurse collaborates with provider offices and care management to promote the most appropriate, highest quality and effective use of clinical services to ensure quality member outcomes, and to optimize member benefits. This position is also responsible with optimization and integration of departments (ie: network management), training/development, resource management, as it may relate to the needs of the respective providers/offices they are assigned to. The position is also responsible in directing the activities of the Medical Management/UM Coordinator in order to fulfill the business needs and initiatives of the department.
Education Certifications/Licensure Experience Physical Abilities MINIMUM JOB REQUIREMENTS/COMPETENCIES:
Requires a LVN with valid unrestricted license in the state of California
AS/BS in nursing and/or Health or Human Services Field; preferred
Certification as a Case Manager (CCM), Utilization Review, Managed Care or similar; desired
Minimum 3 years of clinical (experience in a hospital or urgent care environment a plus) or utilization review experience; managed care experience; preferred or any combination of education and experience, which would provide an equivalent background.
Ability to sit in front of and operate a computer and other essential office equipment for extended period of time.
Ability to bend, lift, and carry objects of varying size weighing up to 25 pounds
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.