Medical Management Nurse (LVN or RN)

Company: Core Recruiting
Location: Modesto
Posted on: February 24, 2021

Job Description:

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.

The Role

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 manner.

Primary Responsibilities

• 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.
  
  Required
  
  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 decision-making skills.
    • 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 minimal supervision.
      Schedule:
      
      • 8-hour shift
      • Day shift 8am-5pm
      • Monday to Friday
        
        Benefits
        
        AllCare offers a fully paid employee benefit package including health, vision, dental, LTC and employer matched 401K with immediate vesting.
        
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Keywords: Core Recruiting, Modesto , Medical Management Nurse (LVN or RN), Executive , Modesto, California