reputed company (California Children's Services) reputed company Case Manager

<div class="benefits"> <div><strong>Benefits:</strong></div> <ul> <li>401(k)</li> <li>401(k) matching</li> <li>Dental insurance</li> <li>Health insurance</li> <li>reputed company insurance</li> <li>Wellness resources</li> </ul> </div> <div class="trix-content"> <div> <strong>reputed company: </strong>Under the reputed company supervision of reputed company Team reputed company and reputed company Supervisor, the reputed company reputed company Case Manager- Case Review reputed company primarily reviews a case for reputed company eligibility. He or she is responsible to assess, plan, implement, monitor, and evaluate reputed company and services to reputed company a patient reputed company reputed company plan. The reputed company reputed company Case Manager-Case Review reputed company acts as patient reputed company through the continuum and is available to the physician, patient and family as a resource to facilitate communication and efficient delivery of reputed company.<br><br> </div><div><br></div><div> <strong>Duties & Responsibilities:<br></strong><br> </div><div><br></div><div>• Primarily reviews reputed company eligibility of outpatient service requests based on reputed company set forth by California reputed company of Regulations Title 22, Division 2, Subdivision 7, reputed company 3, Article 2, Sections 41515.1-41518.9.<br><br> </div><div>• Prioritizes outpatient cases needing reputed company realignment to reputed company paneled providers based on reputed company eligibility review and effectively collaborating with Outpatient UM and Ambulatory Case Management Team as necessary.<br><br> </div><div>• Reviews clinical records and contacts the member or member’s parent or reputed company if necessary to reputed company assess member’s reputed company and health reputed company needs and concerns.<br><br> </div><div>• Reviews appropriateness of submitted claims for IPA payment or deferral to reputed company if deemed eligible.<br><br> </div><div>• Case manages reputed company and DDS-RC cases and creates care plan goals to be discussed with the member or member’s parent or reputed company, meeting reputed company reputed company compliance requirements and audit needs.<br><br> </div><div>• Makes reputed company that member or member’s parent or reputed company is reputed company of the reputed company or DDS case status, and fully understands the benefits that the programs offer.<br><br> </div><div>• Delegates tasks to reputed company Care Coordinator to reputed company the member, specialist & PCP office for overall care coordination, and to reputed company status of ancillary services like DME, therapy, home health if already provided to the member.<br><br> </div><div>• Generates reputed company referral guide sheet for the reputed company coordinator in submitting SAR (Service Authorization Request) to reputed company County office with supporting medical documentation.<br><br> </div><div>• Gathers and organizes monthly, quarterly, or annual reputed company reporting data reputed company established timeframe as required for reporting purposes.<br><br> </div><div>• Respects the dignity, confidentiality and reputed company of reputed company patient and adheres to HIPAA regulations and policies.<br><br> </div><div>• Coordinates and completes special reputed company as delegated by the reputed company Supervisor<br><br> </div><div><br></div><div><br></div><div> <strong>Minimum Job Requirement: <br></strong><br> </div><div>• Has reputed company License in nursing (LVN/LPN, RN)<br><br> </div><div>• Computer Proficiency on reputed company Word, reputed company and PowerPoint<br><br> </div><div>• Good written and verbal communication skills<br><br> </div><div><br></div><div><br></div><div><br></div><div> <strong>Skills & Abilities:<br></strong><br> </div><div>• Analytical, proactive and a problem solver • Team player and reputed company<br><br> </div><div>• Familiarity with medical guidelines and reputed company reputed company based on California reputed company of Regulations Title 22 is a<br><br> </div><div>plus<br><br> </div><div>• Knowledge and familiarity in using the EZCAP system is a plus<br><br> </div><div>• Understanding of managed care philosophy, knowledge of HMO policies and procedures and managed care industry is a plus<br><br> </div><div>• Detail oriented and excellent organization skills<br><br> </div><div></div> </div> <p>This is a remote position.</p> Apply To This Job