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Remote RN Case Manager

Location Irvine, CA 92606
Date Posted January 19, 2021
Job ID 7022
Employment Type Direct Hire
Scion Nonprofit Staffing (www.scionnonprofitstaffing.com) has been engaged to conduct a search for a Remote RN Case Manager for our client, a well-known agricultural nonprofit health insurance provider focused on creating innovative healthcare solutions and benefits to their valued members based out of Southern California. This is completely remote, direct-hire opportunity with an immediate need!
 
Overview
The RN Case Manager will serve as a medical management resource for the business teams and will provide medical expertise to the client. This position will also serve as a liaison with Utilization and Case Management partners.
 
The Perks
  • Fantastic team with an amazing company culture!
  • Direct-hire opportunity with an immediate need!
  • Completely remote opportunity!
  • A competitive salary depending on experience level!
  • A fast-paced environment that will motivate you daily!

What You’ll Be Doing
  • Acting as an internal and external clinical resource for, and maintains professional relationships with claims, underwriting, administration, client services, employer group representatives, stop loss and other customers.
  • Monitors pre-certification and utilization management based on requirements of plan documents and appropriate clinical guidelines.
  • Coordinates and/or monitor the peer review process when established criteria are not met.
  • Provides written precertification, utilization management and peer review determinations internally to support claim adjudication and turnaround times for compliance with internal and regulatory requirements.
  • Identifies potential and actual high dollar/complex cases for internal, stop loss notification and/or case management referral.
  • Monitors clinical case management program.
  • Reviews and monitors case management reporting and case savings by vendors.
  • Establishes and reports outcomes from utilization management and case management programs as required by management.

What You Need to Be Successful
  • Registered Nurse (RN) with Case Manager Certification is desired. 
  • Extensive experience in healthcare cost containment and developing policies & procedures.
  • Extensive broad-based clinical experience (ER, ICU, Medical-Surgical preferred).
  • Maintenance of professional certification through relevant continuing education.
  • Working knowledge of clinical guidelines.
  • Possess critical thinking skills.
  • Must be able to communicate effectively with others through expression of interest, empathy, voice quality, courtesy and in written composition.
  • Must be able to demonstrate ability to accept changing job priorities, learn new skills, and incorporate new skills into day-to-day work activities.

Compensation
A rewarding career and generous salary depending on experience plus a full and robust benefits package including health, dental, vision, disability, retirement with a 100% employer match up to 5% of your annual salary, and a generous amount of paid time off plus all major holidays.

How to Apply
For immediate consideration, please submit your resume and cover letter here: https://www.scionstaffing.com/job/7022

About Our Search Firm
Scion Staffing is a top temporary staffing agency and executive search firm, connecting leading companies and organizations with impeccable talent. Through our innovative team-building and staffing solutions, we bridge the gap in temporary staffing, as well as contract-to-hire employment, contingent search, and executive searches. The Business Times has recognized us as a top staffing from 2010-2019, and our clients return to us for a variety of opportunities.

Scion Staffing is an equal opportunity employer and service provider and does not discriminate on the basis of race, religion, gender, age, gender identity, national origin, citizenship status, sexual orientation, disability, political affiliation or belief, or any other protected class. We are committed to the principles of Equal Opportunity Employment and are dedicated to making employment decisions based on merit and value, for ourselves, our client companies, and for the candidates we represent.
 
 

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