Registered Nurse or LVN Appeal and Denials Case Manager Job

REGISTERED NURSE OR LVN APPEAL AND DENIALS CASE MANAGER needed for a Contract opportunity with Yoh's client located in Fountain Valley, CA.

WHAT YOU'LL BE DOING:

- Case Manager will review, assess, and identify high risk cases and high resource consumptive cases
- Responsible for utilizing advanced nursing skills in the assessment and planning of clinical care for an identified group of patients
- Performs appropriate Utilization Review functions utilizing approved Intensity of Service, Severity of Illness criteria such as InterQual
- Independently performs daily concurrent chart reviews on all assigned patients utilizing approved hospital criteria

WHAT YOU NEED TO BRING TO THE TABLE:

- Registered Nurse Licensure or Licensed Vocation Nurse in State of California (Active and in Good Standing)
- Associates Degree in Nursing
- Three to five (3-5) years of Clinical Experience as a Nurse
- Three to five (3-5) years of Appeals and Denials Case Management Experience in an Acute Care Setting
- Must have InterQual Guidelines Experience
- Basic computer skills and proficiency in MS Word and Outlook required
- Current driver's license in State of CA employed with positive driving record and able to meet requirements of insurance coverage required
- Must be able to exercise independent discretion and judgment (utilizing approved criteria) in the performance of the case management functions
- Must be flexible to help out on the floor and do Case Management when needed.

BONUS POINTS! OTHERWISE KNOWN AS PREFERRED QUALIFICATIONS:

- Bachelor's Degree in Nursing
- Certified Case Manager (CCM)

OPPORTUNITY IS CALLING, APPLY NOW!

RECRUITER: Christine Torres

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

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