Remote RN Case Manager

CALIFORNIA BASED REMOTE RN CASE MANAGER HIRING NOW!!

A large nation wide healthcare network is looking for a REMOTE RN case manager to join their team on a contract basis! Opportunity to gain experience with Medi-Cal and work REMOTELY in a fast-paced environment.

REQUIREMENTS:

• CA RN license
• 2+ years of managed care experience
• 2+ years of acute or subacute care experience
• Clinical experience

WHAT’S IN IT FOR YOU:

• Remote opportunity
• Opportunity for flexible hours
• Gain experience with a leading healthcare organization

Responsibilities:

• Pay: $45 – 50/hr.
• Monday through Friday (day shift) – 830am to 5pm.
• The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial.
• The Medi-Cal Appeals and Grievances senior RN will report to the Appeals and Grievances Manager.
• In this role, you will perform accurate and timely clinical review of Member-initiated appeals.
• The RNs perform first level appeal reviews for members utilizing the National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) guidelines, Milliman Care guidelines, and nationally recognized sources such as NCCN and ACOG.
• The successful RN candidate will review both inpatient and outpatient Medicare member appeals for benefits, medical necessity, coding accuracy and medical policy compliance.
• In this role, you will also perform clinical oversight of all Medi-Cal grievances.
• In this process, the candidate will work with the medical directors and coordinators to identify any Potential Quality Issues (PQI), Quality of Service (QOS) cases and/or Quality of Care (QOC) cases to ensure member’s clinical needs are addressed appropriately within 30 days or 72 hours if the request is deemed expedited.

Experience Level:

Intermediate Level

Pay and Benefits

The pay range for this position is $47.00 – $47.00

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position will be accepting applications until Feb 1, 2025.

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.

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