High Risk Case Manager
Health Care Services
Community Health Group, a locally based non-profit health plan, we are committed to serving the underserved populations in our market. We have consistently been recognized for our outstanding customer service from staff, community, providers, member and employers. We were recently recognized as one of the Top Workplaces in San Diego. We are accredited by NCQA and have been recognized for our quality initiatives especially as it relates to HEDIS scores. We are currently recruiting for: High Risk Case Manager 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. Case management experience in a managed care organization, or other health care setting. Engaged in the following actions: 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-10 codes and principles of case management. Current CA RN license required. Intermediate computer skills. Bilingual preferred.