What are the responsibilities and job description for the RN - Case Manager position at Allmed Staffing Inc?
Large managed care company looking to fill a 1 year RN case manager contract.
Contract end date : 12 / 31 / 2025
Must have CA nursing license
Responsible for the review and evaluation of specialty injectable information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and / or provider issues.
Evaluates documentation / information to determine compliance with clinical policy, regulatory and accreditation guidelines.
Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
Commands a comprehensive knowledge of complex delegation arrangements, contracts, clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation / information.
Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.
Condenses complex information into a clear and precise clinical picture while working independently.
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