Job description
The Case Management Nurse reviews, evaluates and determines the appropriateness, medical necessity and efficiency of health care services proposed or provided, according to established criteria and to improve clinical outcomes and reduce costs. Plans and manages discharge planning, concurrent planning and clinical reviews, pre-certification and clinical case appeals for members who have psychiatric and other complex care needs.
QUALIFICATIONS
· Current California Licensed LVN with two plus years total nursing experience including recent clinical experience in an inpatient acute setting preferably in the behavioral health setting
· BLS within 30 days of entry into position
· Familiarity with clinical criteria guidelines, experience in discharge planning and/or chart review.
JOB SUMMARY
This role focuses on performing utilization and concurrent reviews of inpatient cases using established criteria. Responsibilities include assessing clinical charts, collaborating with physicians and healthcare teams, identifying care delays, and initiating discharge and readmission prevention plans. The role involves coordinating alternative care services, approving inpatient bed days (if applicable), maintaining documentation, and participating in interdisciplinary meetings to ensure timely, effective care and discharge planning. Complex cases are reviewed in consultation with the Physician Advisor.
Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for CMC roles, including but not limited to shift differential and other special pay practices, etc. The posted compensation for the position is a reasonable estimate that extends from the lowest to the highest pay that CMC in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.
Job Type: Part-time
Pay: $35.52 – $44.40 per hour
Work Location: In person
