Telephonic Case Manager/Utilization Review Nurse

Employment Type

: Full-Time

Industry

: Healthcare - Nursing



RN Telephonic Case Manager/Utilization Review Opportunity in El Dorado Hills, CAKelly Healthcare Resources Work with the best in the industry Every day, Kelly Healthcare Resources (KHR) specializes in providing highly skilled nursing and allied health professionals within hospitals and other health care facilities, as well as positions in sectors such as insurance, pharmaceutical, health management and education. We currently have an exciting temporary opportunity for an RN Telephonic Case Manager/Utilization Review in El Dorado Hills, CA. Responsibilities and prospects for RN Telephonic Case Manager include:

  • Case Managers perform a blended function of utilization management UM and case management CM activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members care including clinical nurses and treating MDs
  • Determines develops and implements the plan of care based on accurate assessment of the member and current or proposed treatment plan in cases of : member inquiry, triage hub, chronic conditions, polypharmacy, prenatal care, and voluntary member health assessment, in addition to indication of multiple monthly ER visits
  • Apply detailed knowledge of the company established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case
  • Researches and designs treatment / care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type
  • Implements discharge DC planning activities for medically complex cases
  • Determines appropriateness of referral for CM services
  • Provides Referrals to Quality Management QM , Disease Management DM and Appeals and Grievance department AGD
  • Conducts member care review with medical groups or individual providers for continuity of care, out of area / out of network and investigational/experimental cases
  • Manages member treatment in order to meet recommended length of stay
  • Ensures DC planning at levels of care appropriate for the member's needs and acuity Assessment: Assesses member's health behaviors, cultural influences and clients belief / value system
  • Evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers
  • Negotiates with employer groups when contractually required
  • Researches opportunities for improvement in assessment methodology and actively promotes continuous improvement
  • Anticipates potential barriers while establishing realistic goals to ensure success for the member, providers and the company
  • Determines realistic goals and objectives and provides appropriate alternatives
  • Actively solicits client s involvement
  • Generally requires moderate to extensive experience in nursing, health care or related field

Education and experience for RN Telephonic Case Manager include:

  • Active California RN license in good standing required
  • 1 year of experience

Perks!

  • Weekly electronic pay
  • Access to more than 3,000 online training courses though Kelly Learning Center
  • Group rate insurance options available immediate upon hire*
  • Service bonus plan and holiday pay*
  • Online application system
  • Never an applicant fee

*Perks to be received upon meeting eligibility requirements.



Why Kelly®?

As a worker today, it’s up to you to take charge of your career and look for opportunities to learn, grow, and achieve your potential. Helping you find what’s next is what we’re all about. We know what’s going on in the evolving world of work—just ask the 440,000 people we employ each year. Connecting with us means getting the support, guidance, and opportunities needed to take your career where you may have never imagined.




About Kelly®

At Kelly, we’re always thinking about what’s next and advising job seekers on new ways of working to reach their full potential. In fact, we’re a leading advocate for temporary/non-traditional workstyles, because we believe they allow flexibility and tremendous growth opportunities that enable a better way to work and live. Connecting great people with great companies is what we do best, and our employment opportunities span a wide variety of workstyles, skill levels, and industries around the world.

Kelly is an equal opportunity employer committed to employing a diverse workforce and providing accommodations for people with disabilities in all parts of the hiring process as required under its Employment Accommodation Policy. Kelly will work with applicants to meet accommodation needs that are made known to Kelly in advance.



Job Requirements:

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