RN Case Manager
*Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & all other applicable Federal/state/local laws and regulations *Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities *Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day to day operations *Knowledge of health care benefits associated with various business line (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.). *Must be able to work in a Labor/Management Partnership environment
Preference with Kaiser system Needs RN license for MD/VA and/or DC Seasoned Utilization Review Nurse with preference ER UR Preference experience w/ MCG (Interqual is okay) Familiarity Medicare/Medicaid guidelines for Inpatient, OBS, home health, SNF, DME, acute rehab Ability to apply Case Management Process Accountable, Flexible , Professional, Collaborative, Resource Management, Technologically savvy as this is a Remote Position. Will spend about 20% of the time at New Carrolton/Hyattsville We have a big need for evenings and weekends.