eTeam Inc is seeking a travel nurse RN Case Management Insurance for a travel nursing job in Sacramento, California.
Job Description & RequirementsJob Title: RN Case Manager
Location: Sacramento, CA 95833
Shift: Day 5x8-Hour (08:00 - 04:30)
Duration: 13 weeks
Required:
-CA RN License
-prior UM experience for insurance companies!!
-EPIC & InterQual exp
Conducts preauthorization, concurrent, and retrospective utilization management review using the department’s accepted criteria for ambulatory, acute, and post-acute patients to confirm medical necessity is met and at the appropriate level of care. Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. Strives to promote patient wellness, improved care outcomes, and efficient utilization of health services among a patient population with complex health needs. General Referral Management:• Provides inpatient and ambulatory referral review - manages prior authorizations and retrospective referrals as documented in Utilization Management (UM) Operations Policies and Procedures.• Process referrals based on application of criteria (such as Medicare, MCG, InterQual, health plan, Sutter Health, etc.). Collaborate with UM Medical Directors routinely regarding referrals and all cases not meeting criteria.• Ensure appropriate authorization and denial letters are issued. Work collaboratively with UM staff to handle daily work
About eTeam InceTeam was formed in 1999 with the goal of becoming the company of choice for clients, talent and staffing professionals. Today, we’re one of the fastest-growing global companies and ranked as one of the best companies to work for by Staffing Industry Analysts. We aspire everyday to do quality work for our clients and help our talent work at some of the most amazing companies.
· Benefits: Health and dental insurance
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