Transplant Case Management - LVN - UM in Rancho Cordova, CA at APEX Systems

Date Posted: 6/12/2019

Job Snapshot

Job Description

Job #:  978713

Transplant Case Manager RN/LVN – Rancho Cordova

Day to Day Responsibilities of this Position and Description of Project:
The Transplant case Manager will be working with complex cases promotes the delivery of quality; cost-effective health care services based on medical necessity and contractual benefits. Works with other members of HCS team, provider, hospitals, IPA/MGs, members and their families to plan and review medical necessity, intensity of services, level of care, length of stay and general appropriateness of care. Provides guidance to the provider network. Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care. Will provide case management to member segments with chronic/ catastrophic illness and/or transplant candidates and recipients.
Who YOU Are:
  • Ability to speak with and conduct clinical review with medical directors.
  • Ability to work with Prior Authorization, and other nursing teams to include Appeals & Grievance.
  • Ability to read and comprehend clinical documentation.
  • May need to provide clinical direction to a Health Coach, MSW, Customer Service Rep or to a Clinical Support Coordinator (both are non-clinical positions).
  • Uses concepts and abilities as well as internal policies and procedures to complete assignments and solve problems.
  • Communication/Telephonic Management skills - and ability to work in call center like environment with interruptions
  • 2+ years of UM health plan/ IPA/Med Group experience, concurrent review preferred.
  • Acute care nursing experience – LVN 2 years or greater
  • Previous health insurance experience, insurance/payer knowledge.
  • Documentation and Organizational skills/Time Management critical. Ability to review and extract clinical information from large medical records and write concise, clinical summation and recommendation.
  • Clinical experience – oncology, ICU, CM, and/or transplant.
  • Ability encompasses broad knowledge of concepts, practices and procedures required within health care field. 

Schedule: Monday through Friday 8:00AM – 5:00PM with some flexibility
About Apex:
For over 20 years, Apex has been connecting top professionals with positions at great companies in contract, contract-to-hire, and direct hire positions. We support thousands of job openings per year at companies across North America.
As an employee of Apex, you are valued and part of the Apex family. We provide each employee with an industry-leading benefits program that is designed to support your health, your planning for the future, and your career development.
Apex has resources to support your long-term career and personal development through internal development programs, technical seminars, certification preparation, and certification exam vouchers.
Apex offers several benefits and resources for their employees:
  • Health Insurance
  • Vision and Dental
  • Life Insurance
  • Short and Long Term Disability
  • 401k options
  • Training and Development Programs

To learn more, visit our website:
EEO Employer
Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at 844-463-6178-6178.