RN- Case Management

Immediate need for a talented RN- Case Management. This is a 03 months contract opportunity with long-term potential and is located in Santa Clara, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.

Job ID: 26-05387

Pay Range: $70 - $75 /hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Utilization Management: Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.
• Monitors the progression of the discharge plan and facilitates discussions with the multidisciplinary teams.
• Educates other healthcare team members on utilization and care coordination.
• Collaborates with and provides information to patients, families, physicians, and staff regarding the discharge plans and transitions.
• Understands and consistently applies the interpretation, and utilization of member health care benefits.
• Conducts UM, care coordination and discharge planning activities according to all applicable regulatory requirements.
• Discharge Planning: Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient.
• Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other health care providers and agencies.
• Regulatory: Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements.
• Client Permanente conducts compensation reviews of positions on a routine basis. At any time, Client Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.

Key Requirements and Technology Experience:

• Minimum two (2) years of experience in utilization review, case management, and discharge planning.
• Graduate of accredited school of nursing.
• Diploma/Associate Degree Nursing.
• License, Certification, Registration:
• Registered Nurse License (California)
• Basic Life Support
• Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & all other applicable federal/state/local laws & 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.
• Acute inpatient hospital-level experience
• Bachelors degree in nursing or a health care related field preferred.
• Masters degree in case management preferred.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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