Case Management - Nurse, Senior

Davita Inc.; San Diego (CA); On-site; USD 80,000 - 120,000; Full time

Job summary

A leading healthcare organization is seeking a Senior Case Management Nurse to join their Case Management team in San Diego. This role involves clinical judgment and independent analysis in developing care plans based on comprehensive member assessments. Ideal candidates will have extensive nursing experience, particularly in managed care, and possess the ability to operate relevant software proficiently.

Qualifications

• Current CA RN License required.
• 5+ years experience in nursing or healthcare.
• 3 years managed care experience preferred.

Responsibilities

• Determine and implement care plans based on assessments.
• Collaborate with clinical nurses and treating MDs.
• Manage cases including chronic conditions and ER visits.

Skills

Independently assess clinical information

Critical thinking

Coordination of care

Knowledge of clinical practice guidelines

PC-based software proficiency

Education

Bachelors of Science in Nursing

Certified Case Manager (CCM) Certification

Tools

Microsoft Office 365

Job description

Your Role

The Case Management team performs and case management (CM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members care including clinical nurses and treating MDs. The Case Management Nurse, Senior will report to the Manager, Care Management. In this role you will determine, develop and implement the plan of care based on accurate assessment of the member and current or proposed treatment plan in cases of member inquiry, triage hub, chronic conditions, poly-pharmacy, pre-natal care, and voluntary member health assessment, in addition to indication of multiple monthly ER visits.

Your Knowledge and Experience

• Requires a current CA RN License


• Bachelors of Science in Nursing or advanced degree preferred.


• Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements


• Requires at least 5 years of prior experience in nursing, healthcare or related field


• At least 3 years of managed care experience preferred


• Demonstrated ability to independently assess, evaluate, and interpret clinical information and care planning.


• Extensive knowledge of evidenced based clinical practice guidelines particularly for chronic conditions.


• Incorporates professional judgment and critical thinking when determining medical necessity that promotes quality, cost-effective care.


• Knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care and length of stay criteria sets preferred


• Able to operate PC-based software programs including proficiency in Microsoft Office 365 applications including Word, Excel, Outlook and Teams.