Successful candidate will promote optimal quality and cost effective health care services to members by:
- Conducting telephonic and onsite clinical reviews
- Inpatient hospital reviews for targeted high risk members
- Providing case management for targeted high risk members
- Reviewing and processing referrals for high risk members
- Providing proactive case management in collaboration and coordination with primary care providers, specialty, ancillary providers, other key health plan staff and key community based resource agencies.
Would prefer candidates with 1 year experience in a managed care organization, case management, disease management, or authorization referrals processing according to standard clinical (such as Milliman USA). Knowledge of Medicare/Medi-Cal HMO benefits, CPT and ICD-9 codes and principles of case management. Will consider new graduates with Associates degree in health related field. Current CA RN license required. Intermediate computer skills. Bilingual required.
For consideration, please send resume to: Community Health Group, Human Resources Department, 2420 Fenton Street, Suite 100, Chula Vista, CA 91914; e-mail resume or fax to (619) 476-3819. www.chgsd.com. Equal Opportunity Employer.
Indeed - 4 months ago
Community Health Group is a nonprofit health plan operating in San Diego County. We have been providing health care services to San Diego...