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Ambulatory Continuity of Care Registered Nurse (RN) - Simi Valley

Company: Yoh Staffing Services
Location: Simi Valley
Posted on: January 27, 2019

Job Description:

Ambulatory Continuity of Care Registered Nurse (RN) needed for a full-time, long-term opportunity with Yoh's client located in Los Angeles, CA

Top Skills You Should Possess:


  • Registered Nurse license in state of California
  • Bachelor of Science degree in Nursing is --preferred
  • Minimum of three-five (3-5) years' experience as a Registered Nurse in an ambulatory care setting
  • Minimum of two-three (2-3) years' of recent experience as a Case manager in an managed care setting
  • Knowledgeable in Robertson and Milliman guidelines is required.
  • Strong interpersonal, verbal and written skills are required when summarizing medical and insurance information.
  • Must be able to demonstrate the knowledge and skills necessary to provide appropriate case management specific to the age of the patients served on assigned units. Case Managers are assigned patients ranging in age from neonates to geriatrics.


    What You'll Be Doing:


    • Provide first level, clinical review, for all outpatient, elective inpatient and ancillary services requested for authorization
    • Utilize decision-making and critical thinking skills in the review and determination of coverage for medically necessary health care services and will process all prior authorizations to completion or forwards to the Medical Director for next level for review with all necessary information needed for proper determination
    • Independently performs daily concurrent chart reviews on all assigned patients utilizing approved hospital criteria (Medi-Cal and managed care patients require daily review regardless of criteria recommendation).
    • Utilize appropriate health plan medical guidelines and medical review criteria and use of DOFR.
    • Responsible for carrying out the management of specific, individual medical episodes identified through utilization review and quality assurance functions, determine appropriateness of care from diagnosis to outcome, including the coordination of the care
    • Consistently maintains production and quality standards in accordance with department policy.


      What You Need to Bring to the Table:


      • Flexibility to work Monday-Friday 8:00 am to 5:00pm
      • BLS/CPR certified from AHA
      • Registered Nurse License in State of CA
      • BS Degree in Nursing is preferred
      • Must have updated MMR/Varicella Titres, Physical, PPD and Flu vaccinations.


        --

        Keywords: Yoh Staffing Services, Simi Valley , Ambulatory Continuity of Care Registered Nurse (RN) - Simi Valley, Healthcare , Simi Valley, California

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