Referral Nurse - Managed Care Job

REGISTERED NURSE (RN) - REFERRAL NURSE needed for a CONTRACT opportunity for Yoh's client located in Ontario, CA.

THE BIG PICTURE:

The Referral Nurse will be responsible for receiving and reviewing referral requests to ensure appropriate utilization and timely delivery of health care services and providing a linkage system for a standard operational process for the flow information between the member, or legal representative, and appropriate providers through communication, coordination and monitoring of services.

What You'll Be Doing:
- Referral Management responsibilities and functions include
- Supervises daily management of TAT for Case Management and UM Technician staff in collaboration with the Lead UM Technician.
- Supervises daily management of the error reports for Case Management and UM Technician staff in collaboration with the Lead UM Technician.
- Ensures that all STAT/URGENT Expedited requests are reviewed and that a final determination is completed and communicated within the required regulatory or internal guidelines
- Identifies potential transition of care needs and makes necessary referrals to the care management team to follow-through and meet these needs, if identified

What You Need to Bring to the Table:
- RN or LVN license required.
- CCM certification preferred.
- Two (2) to five (5) years managed care/IPA experience.
- Solid knowledge of general IPA operations.
- Solid experience using Interqual or Milliman guidelines.
- Computer skills using Outlook and other Microsoft Office products.

WHAT ARE YOU WAITING FOR? APPLY NOW!

RECRUITER: Jennifer Yerkes

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Please contact us if you are an individual with a disability and require accommodation in the application process.

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