Category: Utilization Management Department
Description: Under the direction of the Kern Health Systems (KHS) Medical Director and 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. Eligible For Sign-On Bonus of $2,000.00.
Requirements: Minimum of two(2)years full-time experience or its equivalent as a registered nurse in an acute care hospital, at least one (1)year of which was working within a medical/surgical ward or unit. Three(3) years of full-time, paid work experience equivalent to that gained as a UM Case Manager with Kern Health Systems. Bachelor’s Degree in Nursing, Health Administration or related healthcare field preferred. Current (RN)license; Valid California Driver\'s license and proof of auto liability insurance required. Bilingual preferred. We have an excellent benefit package to include: health care, dental, life, 457 and 401a plan, PTO and EIB, and other benefits, such as short- and long-term disability insurance and supplemental benefits. As a condition of employment, a satisfactory drug test and background check are required. E.O.E #079-13