Registered Nurse – Case Management- Case Manager

Registered Nurse – Case Management
- Case Manager REQUIREMENTS

• Inpatient Case Management experience
• Understanding what an AB1203 is and the law surrounding that
• General insurance understanding (What is generally NOT covered by insurance - Caregivers, cSNF stays [unless Medi Cal], Board & Care, ALF)
• What HH services are generally available (RN/PT/OT/ST/MSW/HHA)
• Medicare Compliance
• +3 midnight rule
• +Need to know and understand MOON / IM Letters
• +Should understand Medicare appeal rights and the general process (IE: pt calls Commence, 3rd party review explanation, 3 day turn around, final determination, and resolution results) - we can show them the KP process, but the general process they should understand
• Understanding of different methods of transport (IE: BLS/ALS/CCT/Gurney Van/WC Van) and how they are selected for patients
• Understanding the need to identify CG/family available and transport at d/c
• Experience identifying Social Work vs PCC needs
• Experience with insurance coverage declination and having that difficult conversation with patients/families
• Gen understanding of criteria for HH and sSNF
• UM/UR experience with either IQ or Milliman, though IQ would be preferred

• Experience with Wellsky (AKA Allscripts / Care Port / Extended Care) for IQ, SNF referrals, HH referrals.
• Experience with Vector Care
• Experience working MS Teams (chats and channels)
• Experience arranging IV Abx at home
• Experience arranging Tube Feeds at home

• Competitive pay rates
• Free, quality, private housing
• Medical, Dental, Vision
• 401(k) and Flex Spending
• Life Insurance
• Accident and Short-term Disability Coverage
• Free Continuing Education
• Refer a friend and earn extra cash!

Nestled in the center of the world-famous Sonoma wine country, just 55 miles north of San Francisco, Santa Rosa offers a unique blend of art and culture, food, wine and recreation. Explore the region’s many world-class wineries, take a hot air balloon ride over the stunning countryside, relax at a world-class spa or enjoy mouth-watering cuisine at one of the city’s numerous award‑winning restaurants.

At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.

* Estimate of weekly payments is intended for informational purposes and includes hourly wages, as well as reimbursements for meal & incidental expenses and housing expenses incurred on behalf of the Company. Please speak with a recruiter for additional details.

Qualified Applicants with arrest or conviction records will be considered for Employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.