Care Manager – Mercy San Diego

Required Education/Experience/Specialized Skills:

•  2+ years clinical experience 
• Demonstrate knowledge of utilization management including experience managing prior-authorization and concurrent review. 
• Excellent verbal and written communication (including documentation) skills demonstrated by completing the required forms and the ability to work effectively with individuals and or teams across disciplines. 
• Ability to independently utilize critical thinking skills, nursing judgement and decision-making skills.
• Ability to prioritize, plan, and handle multiple tasks/demands simultaneously as evidence by capacity of open cased, active care plan rate and the ability to handle multiple tasks. 
• Ability to read, analyze and interpret information in medical records, and health plan documents. 
• Demonstrates knowledge in Microsoft Office applications including Outlook, Word, and Excel

  Required Certification/Registration: 

• Current California RN License. 

• BLS for Health Care Provider as needed for direct patient contact and department need. 

  Preferred Education/Experience/Specialized Skills/Certification:

   

•  Bachelor of Science in Nursing (BSN) highly desired. 
• Case management certification highly preferred. 

• Knowledge of Medicare and Commercial health plans. 3+ years of diverse clinical experience; 

  preferred in caring for the acutely ill patients with multiple disease conditions.

   

•  3+ years of managed care and/or case management experience.