Local ContractLocal Contract LPN / LVN - Case Management
$37-55/hour
Local Contract LPN / LVN - Case Management
Orange, CA
Equiliem
5x8 hrs, Days
$37-55/hourPosted 12 days ago
Overview
- Start DateASAP
- Shift Breakdown5x8 hrs
- ShiftDays
- Duration26 weeks
Pay
Estimated pay
$37-55/hourDescription
Looking for a great Local Contract Case Management Job in Orange, California? Equiliem posted this Case Management Local Contract Nursing Job that includes 40 hours a week on the 5x8 hrs shift in Orange, California.
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The details for this Local Contract Case Management Nursing Job are:
- Specialty: Case Management
- Job Location: Orange, California
- Estimated Salary: $37-55 per hour
- Start Date: ASAP
- Total Hours Per Week: 40 weekly
- Shift Breakdown: 5x8 hrs
The Medical Case Manager (LVN) (Pre-Authorization Nurse Reviewer) will be responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities and ancillary providers. The incumbent will be responsible for prior authorization and referral related processes, including on-line responsibilities and select off-line tasks. The incumbent will utilize CalOptima Health’s medical criteria, policies and procedures to authorize referral requests from medical professionals, clinical facilities and ancillary providers. The incumbent will directly interact with provider callers and serve as a resource for their needs.
Position Responsibilities:
85% - Medical Review Support
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Reviews requests for medical appropriateness.
Verifies and processes specialty referrals, diagnostic testing, outpatient procedures, home health care services and durable medical equipment and supplies via telephone or fax using established clinical protocols to determine medical necessity.
Screens requests for the Medical Director’s review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director’s decision and documents follow-ups in the utilization management system.
Completes required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates.
Reviews International Classification of Diseases (ICD-10), Current Procedural Terminology (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and existence of coverage specific to the line of business.
Contacts the health networks and/or CalOptima Health’s Customer Service department regarding health network enrollments.
Identifies and reports any complaints to the immediate supervisor utilizing the call tracking system or verbal communication if the issue is urgent.
Refers cases of possible over/under utilization to the Medical Director for proper reporting.
Meets productivity and quality of work standards on an ongoing basis.
10% - Administrative Support
Assists the manager with identifying areas of staff training needs and maintains current data resources.
5% - Other
Completes other projects and duties as assigned.
Possesses the Ability to:
Demonstrate strong problem solving, organizational and time management skills along with the ability to work in a fast-paced environment.
Establish and maintain effective working relationships with CalOptima Health’s leadership and staff.
Communicate clearly and concisely, both orally and in writing.
Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment.
Experience & Education
High School diploma or equivalent required.
Current, unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California required.
3 years of nursing experience required, 1 year of which must be as a nurse reviewer.
1 year of utilization management/prior authorization review experience required.
An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Preferred Qualifications
Active Certified Case Manager (CCM) certification.
Managed care experience.
Knowledge of:
Current CPT-4, ICD-10 and HCPCS codes and continual updates to knowledge base regarding the codes.
Medical terminology.
Medi-Cal and Medicare benefits and regulations.
#24-16452
Employer
Equiliem
5.0rating(1 review)
5.0rating
Great recruiter
He's always available,gets me access to jobs asap. He is awesome I've been working under him since 2020! 5 stars all around.Excellent recruiter I recommend him to all my friends and anyone interested in looking for a job!
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Rachel B
CMA (CMA)
Response timewithin an hour
Travel jobs$3,060–3,060/week
Jobs on Vivian190
About Orange, CA
As a travel nurse in Orange, CA here's what you should know:Cost of Living
- The cost of living in Orange, CA is higher than the national average.
- Wages may be higher to match the cost of living.
Weather
- Average summer highs are around 85°F and winter lows around 45°F.
Furnished Housing
- Short term rentals are available but may require some searching due to high demand in the area.
Transportation
- Orange, CA is car-friendly with good freeway access.
- Public transportation options are available within the city and to neighboring areas.
Demographics
- The population is diverse with a wide age range.
- Common health issues may include allergies due to the warm climate.
- There is a substantial population of travel nurses in Orange, CA.
Things to Do
- Plenty of restaurants, art galleries, and music venues can be found in Orange.
- Sports enthusiasts can enjoy local parks and golf courses, and outdoor activities are popular due to the city's proximity to beaches and hiking trails.
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