Offer summary
Qualifications:
Current and unrestricted California RN License, 2+ years of experience in Pediatric Case Management/Utilization Management, Knowledge of Medi-Cal and Medicare regulations, Experience working with managed care organization, Bilingual in Spanish highly preferred.
Key responsabilities:
- Perform utilization management activities and case management.
- Communicate effectively with providers, members, and teams.
- Review member’s CCS Annual Medical Review.
- Coordinate care transitions and identify gaps in care.
- Develop and implement individualized care plans.