Job Requirements:
Five years recent case management experience in a general acute care setting, with three years management level experience
Demonstrated knowledge of payor mechanisms, Managed Care (IPA) management, and clinical utilization management (RAC preparedness and third party payors)
Knowledge of post-acute care community resources
Experience with leading Utilization Committee
Demonstrated knowledge of Title 22, Medicare Conditions of Participation, InterQual criteria, NCQA, AAAHC requirements and standards related to Utilization Management/Case Management, Patient Rights, Information Management, and Discharge Planning
Excellent organizational and communication (verbal and written) skills are necessary.
Bachelor’s degree
Current CA RN license.