Registered Nurse (RN) Case ManagerPosition OverviewSeeking a
Registered Nurse (RN) with pediatric and/or case management experience to support a
Public Health program serving children from birth to 21 years of age with complex medical conditions, including cancer, cerebral palsy, and other chronic illnesses. This position is highly administrative and review-focused, involving medical record review, eligibility determinations, and authorization processing.
This is a temporary assignment is expected to last approximately
12 weeks.
Key Responsibilities - Review and evaluate medical records and clinical documentation
- Determine medical eligibility for program services
- Process authorizations and denials based on clinical criteria
- Conduct utilization-management-style medical reviews
- Manage a high-volume caseload efficiently and accurately
- Complete approximately 10-15 case reviews per day
- Perform extensive computer-based documentation and case tracking
Patient PopulationChildren ages birth to 21 years old with complex medical conditions, including:
- Cancer
- Cerebral palsy
- Chronic and medically complex diseases
Required Qualifications - Active RN license
- BSN required
- Experience in case management and/or pediatrics
- Strong computer and documentation review skills
Preferred Qualifications - At least 1 year of RN case management experience
- Pediatric case management experience strongly preferred
- Bilingual skills preferred but not required
Caseload & Productivity - Assigned caseload: approximately 550 cases
- Expected productivity: 10-15 reviews per day
- Training provided to support productivity expectations
Schedule - Monday - Friday
- 8:00 AM - 5:00 PM
- ONSITE ROLE
* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
* As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.