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Registered Nurse Adult Utilization Management

Company: Yoh, A Day & Zimmermann Company
Location: Santa Barbara
Posted on: January 10, 2022

Job Description:

Registered Nurse Adult Utilization Management (RN) needed for a full-time, DIRECT HIRE opportunity with Yoh's healthcare organization client located in Goleta, CA.

Job will begin as a remote position during this COVID-19 crisis. The site is talking about potentially reopening February 2022 and you must be willing to work onsite (hybrid schedule) in Goleta when they do open.

Position Overview: Depending on the unit assignment, the HPNC may perform Utilization Management activities which may include Case or Disease Management, Care Coordination or Transition, or Quality Improvement activities (or a combination of all).

Top Skills You Should Possess

  • Active/unrestricted Registered Nurse (RN) license in state of California
  • Preferred = 2 - 3 years of case management and/or utilization management experience
  • Preferred = Certified Case Manager (CCM)
  • Preferred = knowledge of Medi-Cal and/or Medicare Advantage Plans
    What You'll Be Doing
    • Assess, plan implement, coordinate, monitor, and evaluate the options and services
    • Act as an advocate for medically necessary services for the member, facilitating care transitions, and communicating with providers to assure medical needs of the member are being met.
    • Coordinate and manage specific members (includes complex care members and seniors/persons with disabilities) for defined periods of time and/or post discharge transition from an inpatient setting (ie acute care hospital, skilled or long-term care facility)
    • Support and collaborate with the management and health services team members in the implementation and management of Utilization Management, Case Management, Disease Management, Quality Improvement, Care Coordination, and Care Transition activities
    • Demonstrate proficiency in the development, implementation and outcome measurement of Individualized Care Plans (ICP)
    • Evidence that ICPs are developed in a timely manner, clear and concise, member-centric, and have limited changes to goal/outcome completion timeline
      What You Need To Bring To The Table
      • Excellent organizational and time-management skills
      • Demonstrate ability to critically think, problem solve, and make independent decisions supporting the case management process
      • Experience working with Medi-Cal patients (proficient understanding of Medi-Cal coverage and limitations)
      • Computer savvy (preferred experience with Essette or EPIC and MS Office products like Word, Excel, and PowerPoint)
      • Bilingual in Spanish a huge plus!
        What's In It For You?
        • Competitive pay with opportunities for advancement
        • Stable company that offers a pension plan, professional development and wellness benefits, and comprehensive medical, dental, vision, and life insurance
        • Great team to work with!
        • Potential for relocation assistance to those that qualify
          Recruiter: Marine Kokoshyan

          #Zip-SPG

          #CB-SPG

          #IND-SPG

Keywords: Yoh, A Day & Zimmermann Company, Santa Barbara , Registered Nurse Adult Utilization Management, Executive , Santa Barbara, California

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