Hiring an Outpatient Utilization Review Nurse for a great company in Sacramento, CA!! This would be fully remote. Must have qualifications below to apply!

• CA LVN License
• At least 1 year of LVN experiences in a SNF or acute care setting

Responsibilities

Shift- Monday-Friday day shift

• The Clinical Case Manager coordinates all systems/services needed for an organized, multidisciplinary, patient centered team approach, and cost-effective care for Managed Medi-cal patients
• The Clinical Case Manager follows and manages the course of treatment for patients while coordinating care with physicians, nurses, case managers
• The Case Manager is responsible for managing a continuum of care from admission through discharge for assigned patients
• The Case Manager partners with medical staff, utilizes scientific evidence for best practices, relevant data and compliance with the mission/philosophy, standards, goals and core values
• Proactively assesses all potential case management and CCS member cases identified from either external or internal sources and actively manages all high risk, high volume cases throughout the continuum of the member’s health care needs or until they reach a maintenance mode
• Demonstrates a multidisciplinary approach in identifying problems, communication and negotiating with the member’s PCP, family members, caregivers, other members of the health care team, community resources and the Health Plans
• Participate in the development of patient focused long/short term goals, implementing, evaluating and modifying the care plan
• Researches and refers members to sources for alternative funding, community services and other services which may provide support to the patient and family
• Tracks all CCS referrals for timely notification of decisions
• Assists Medical Director with CCS appeals
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.