Description: Under the direction of the Kern Health Systems (KHS) Administrative Director of Health Service and the UM Clinical Inpatient Supervisor, the Remote UM RN 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.
The Remote Based Weekend UM Nurse RN is responsible for assigned utilization case management functions for a Knox-Keene licensed health maintenance organization (HMO). The UM Nurse RN is required to demonstrate competency in the knowledge of and skills in protocols for utilization management, discharge planning and/or case management, including the most difficult aspects. This may involve functioning at a higher capacity of utilization review, such as routinely assisting in the training, mentoring and assignment review of lower-level UM Case Managers and Support Staff, as well as assisting management with varied assignments. Incumbents are expected to possess an advanced knowledge of health care delivery systems and HMO regulatory requirements, including DMHC and CMS compliance.
Eligible for Sign-On Bonus of $2000.00
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 Nurse with Kern Health Systems; Bachelor’s Degree from an accredited school or equivalent in Nursing, Health; Administration or related healthcare field preferred; Current California Registered Nurse License RN; Valid California Driver License and proof of State required auto liability insurance; Bilingual preferred. Minimum distance of 50-100 miles from KHS headquarters required to be considered as a remote employee; Intermittent travel for KHS onsite meeting attendance as determined by management.
We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits. As a condition of employment, a satisfactory drug test and background check are required. E.O.E.