Clinical Nurse Specialist Rn Case Manager Job


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Amtec Inc

Summary of Clinical Nurse Specialist Rn Case Manager job

  • Salary $97,000 Annually
  • Benefits Offered Vision, Medical, Life Insurance, 401k, Dental
  • Employment Type Contractor

The Clinical Nurse Specialist (RN Case Manager), is responsible for investigating and processing comprehensive and complex greivances and appeals requests from members and providers, coding justifications, and provider disputes. This position identifies through clinical review any system or processing issues that resulted in failure to provide
appropriate care to members, failure to meet service expectations, billing concerns, and provider disputes. The Clinical Nurse Specialist has a dotted-line reporting relationship to the Chief Medical Officer.

EDUCATION OR TRAINING EQUIVALENT TO:

  • Active and unrestricted California Registered Nurse; and
  • Bachelor's degree preferred.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

  • Minimum three years acute care clinical experience required;
  • Minimum two years of experience in appeals and grievances casework required;
  • Utilization Management or Quality Management experience preferred;
  • Experience using standardized clinical guidelines preferred
  • Milliman Care Guidelines (MCG), Managed Care and NCQA experience preferred.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

  • Strong knowledge of accreditation, federal and state regulations/requirements;
  • Knowledge of risk management principles;
  • Ability to effectively analyze, interpret, apply and communicate policies, procedures, provider
  • contracts, and regulations;
  • Strong analytical and problem solving skills;
  • Excellent verbal and written communications skills;
  • Excellent case preparation, clinical judgment, and abstracting skills;
  • Team player who builds effective working relationships;
  • Ability to work independently;
  • Detailed knowledge of managed healthcare and Evidence of Coverage (EOC);
  • Medical coding knowledge;
  • Strong organizational skills; and
  • Proficient in Microsoft Office suite including, Access and Project.

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About Amtec Inc company & reviews

Amtec Inc.

Why Work Here?

Recognized For Excellence Several Times By Some Of The Most Trusted Organizations In The Country.

At Amtec, We Care About You And Your Career. Since 1959, We Have Changed The Lives Of Thousands Of People For The Better - People Just Like You. It Is Our Goal To Help You Find Meaningful Work By Matching Your Character, Competence, And Culture With An Organization That Truly Values What You Have To Offer. Whether You Want A Contract Assignment, A Temp-to-perm Job, Or A Regular Full-time Position, We Are Here To Be Your Partner Throughout Your Whole Career.

Address

Alameda, CA 94502
Alameda, CA
USA

Website

+ PRO
worked with your hands and also there was new jobs to learn everyday
- CONS
working with small parts working at a fast pase jobs
Culture And Values:

3.2
Senior Leadership:

3.2
Compensation And Benefits:

3.2
Career Opportunities:

3.2
WorkLife Balance:

3.6
Sharing:

100% recommended Amtec Inc company to a friend
Overall Rating:

3.3 based on 3 reviews
Company review

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About Amtec Inc Company

  • George L. Dressel III ( President and CEO )
  • Vacancy Location: Alameda, CA
  • Vacancy job: Clinical Nurse Specialist Rn Case Manager
  • Rate: negotiable
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