EDUCATION
Graduate from an accredited school of nursing or other clinical related field required
BA degree in health related field preferred
Certification in case management preferred.
EXPERIENCE/SKILLS
2 years’ experience as a high risk case manager and 1-year experience in a managed care environment, hospital discharge planning or outpatient clinic is required.
1 year of supervisory experience preferred.
Knowledge of population health, care/case management clinical operations, and management expertise relating to business planning, process improvement, budget administration, and personnel management.
Working knowledge of Microsoft programs; proficiency with Word and Excel.
Knowledge of managed care principles, CPT, ICD-10, HCPCS coding, experience with inpatient and outpatient medical review guidelines (MCG).
Familiar with Medi-Cal, Medicare. Familiar with Web based standard of care sites i.e. NIH, ACOG.
Ability to communicate effectively verbally and in writing; exceptional telephone and customer service skills; ability to establish effective working relationships with physicians and medical professionals;
May be required to conduct in-person visits and assessment of members.
OTHER REQUIREMENTS
Prolonged periods of sitting at desk; intermittent standing, walking and bending.
May be necessary to work and attend meetings outside of facility or normal business hours.
Lifting 10 lb. or less.
Driving within County of San Diego
California driver’s license in good standing.
**Must have current authorization to work in the USA**
Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.