Medical Management Nurse (LVN or RN)
Company: Core Recruiting
Posted on: February 24, 2021
Medical Management Nurse/LVN/RN, Modesto
AllCare IPA and AllCare Medical Group are represented by over 1,000
private practice physicians and multiple contracted health plans,
in Merced, San Joaquin, and Stanislaus Counties. Founded in 1989,
AllCare is a growing and dynamic organization focusing on
prevention of illness and promotion of healthy lifestyles.
At AllCare, our commitment is to health through the caring
partnership of patients, physicians, and medical professionals. We
are dedicated to offering every member quality health care that not
only meets their expectations but sets standards for caring,
convenience, and accessibility.
Join the excellent Medical Management staff as we are hiring a
Medical Management Nurse (LVN or RN) located in Modesto, CA. This
full-time position is open to Registered Nurses and Licensed
Vocational Nurses who possess a very strong history in the acute
hospital setting. In this role the Medical Management Nurse
utilizes the Nursing Process, the tenets of managed Care and
AllCare's utilization management requirements to ensure the
delivery of quality health care in a timely and cost-effective
- The Medical Management Nurse will be reviewing outpatient care,
utilizing the tenets of managed care and the IPA's Utilization
Management requisites to ensure the delivery of quality care in a
timely and cost-effective manner. Uses Milliman and Apollo plan
guidelines and other resources, including plan guidelines,
appropriately and consistently.
- Creates Care Plans using knowledge of benefits, benefit
limitations, and available community resources.
- Enters data as required by written workflows and policy.
- Utilizes physician reviewers for appropriateness of care.
- Exemplifies excellent communication and customer relations with
staff, physician offices, facility staff and members.
- Strong knowledge of quality care issues and appropriately
refers matters to the Quality department
- Documents and meets timelines.
- Document and records information in a timely fashion.
- Maintains confidentiality. Responds professionally in dealing
with confidential areas.
- Understands the Case Management process and appropriately
refers cases to Case Management.
- Participates in continuing education through seminars,
workshops and national organizations.
- Has the ability to be flexible, adjust quickly and reacts
positively to change.
- Accepts other duties as assigned, including special projects
and task force work.
Education and Experience
- Current unrestricted California RN or LVN license.
- 5 plus years of recent Utilization and/or clinical nursing
experience is required
- Proficiency in Microsoft Word suite, Electronic UM/CM Medical
Records platforms(and other Analytic tools
- Experience with Medicare/Medicare Advantage Plans, Commercial
Plans as well as HMO plans.
Essential Skills And Abilities
- Demonstrated Leadership ability
- Proven and effective problem-solving, critical thinking, and
- Collaborative, team-oriented approach to decision-making.
- Able to communicate effectively, think critically; manage
multiple assignments effectively; organize and prioritize workload;
work well under pressure; problem solve; recall information with
accuracy; pay close attention to detail; work independently with
- 8-hour shift
- Day shift 8am-5pm
- Monday to Friday
AllCare offers a fully paid employee benefit package including
health, vision, dental, LTC and employer matched 401K with
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Keywords: Core Recruiting, Modesto , Medical Management Nurse (LVN or RN), Executive , Modesto, California
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