Department: Utilization Management Department
Description: Under the direction of the Kern Health Systems (KHS) Director of Health Service the U.M. Case Manager will promote coordination and continuity of care and quality management in both the inpatient and ambulatory care settings by the review of referrals and authorization of payment for specialty care and ancillary services. The review will evaluate the appropriateness of care using established criteria and Plan benefit guidelines. Review will be conducted on a prospective, concurrent, and retrospective basis. The UM Case Manager manages the required caseload on a monthly basis. Additional duties may include discharge planning and telephone triage functions.
Requirements: Minimum of two years (2) full-time experience or its equivalent as a nurse in an acute care hospital, at least one (1) of which was working within a medical/surgical ward or unit. One (1) year of previous UM/QM experience in a managed care setting preferred. Bachelorís Degree in Nursing, Health Administration or related healthcare field preferred. Registered Nurse with an active, current, unrestricted license, Possession of valid driverís license and proof of State required auto liability insurance. Bilingual preferred. We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits. Note: As a condition of employment, a satisfactory drug test and background check are required. E.O.E Req #091-13