Inpatient Review Nurse (RN/LVN) Must have California Licensure

Required: Minimum (3) years' general case management skills. Minimum (2) years' experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation Length of stay: including review of diagnosis and length of stay. Minimum (2) consecutive years related experience in a managed care setting as an inpatient case manager Preferred: Experience with a senior population. Education Required: Successful completion of an accredited Licensed Vocational Nursing Program Preferred: Associates or Bachelors Degree Specialized Skills Required: Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. Excellent critical thinking skills related to nursing utilization review Knowledge of Medicare Managed Care Plans Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Report Analysis Skills: Comprehend and analyze statistical reports. Preferred: Knowledge and experience in complex / catastrophic case management preferred Licensure Required: Must have and maintain an active, valid, and unrestricted RN license in California (Non-Compact) Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, hand, or feel and talk or hear. The employee is frequently required to reach with hands and arms The employee is occasionally required to climb or balance and stoop, or kneel The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

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