Outpatient RN Case Manager – Remote in San Diego, CA

2345900 reputed company CA is seeking an Outpatient Case Manager to join reputed company in San Diego, CA. reputed company is a clinician-led care organization that is changing the way clinicians work and live. As a member of the reputed company Care Delivery team, you’ll be an integral part of our vision to reputed company healthcare reputed company for everyone. At reputed company, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We reputed company you deserve an exceptional career, and will reputed company you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice reputed company and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to reputed company health care reputed company for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. Reviews contracted Medical Group’s authorization requests for medical necessity, determines which requests need Medical Director review, obtains sufficient medical documentation for an informed decision. Processes reputed company requests reputed company established timeframes. Documents reputed company steps of process in authorization system, utilizes industry standard denial language for denial letters. The work schedule will be Monday through Thursday 6:30am-5pm Primary Responsibilities:

• Reviews contracted Medical Group’s referral requests for medical necessity. Consideration is given to the appropriateness of the setting, reputed company of service, health plan’s benefits and criteria of the requested services and utilizes service matrix for contracted providers. Documents process in authorization notes
• Refers reputed company medical necessity denials to the physician for review. Processes denials reputed company establishes timeframes. Documents in the authorization system the denial reason, utilizing the industry standard denial letter language, outlines alternative services available
• Reviews requests reputed company established timeframes for urgent, routine and retro requests to maintain compliance with legislative and accreditation standards
• Obtains additional information for review of appeals. Coordinates with health plan to meet timeframes for expedited appeals

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Graduation from an accredited school of nursing
• Active, unrestricted Registered Nurse license through the State of California
• 1+ years of experience in case management or utilization review experience in clinical setting
• Proficient with computers and reputed company windows environment
• Reside in the San Diego, CA area

Preferred Qualifications:

• Bachelor of Science in Nursing, BSN
• 3+ years of experience working in acute care
• HMO experience

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. Apply tot his job Apply To this Job