OUTPATIENT CASE MANAGER Conducts medical review, discharge planning and care coordination for outpatient member care in accordance with the company policies and procedures. Current California RN/LVN license required; BA prefd. 5+ years of clinical experience reqd. Knowledge of practices and regulations regarding patient care. Familiarity with regulatory requirements for managed care and HMOs. OUTPATIENT UM COORDINATOR Utilize designated criteria and apply benefits information along with clinical knowledge to make authorization and assist the Medical Director with review determinations. Responsible for appropriate utilization of resources in compliance with Division of Financial Responsibility for commercial and Medicare contracts. Current California RN...read more

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