Offer summary

Qualifications:

Must possess a valid CA RN License., Minimum of 3 years of experience in Hospice care., Experience in Managed Care and Case Management is strongly preferred., Health Plan experience is a plus..

Key responsabilities:

Review Hospice-related documentation including physician orders and election forms.

Contact non-par Hospice providers and CA members to coordinate care.

Load pseudo authorizations into the CA Health Plan's systems if documentation is accurate.

Report any suspected fraud, waste, and abuse.

Job description

APN Consulting, Inc. is a progressive IT staffing and services company offering innovative business solutions to improve client business outcomes. We focus on high impact technology solutions in ServiceNow, Fullstack, Cloud & Data, and AI / ML. Due to our globally expanding service offerings we are seeking top-talent to join our teams and grow with us.

Job Title: Case Manager II
Location: Remote (Must possess a CA RN License)
Duration: 3 Months

Summary:
Reason for Job Request: Two temp to hire Case Manager, Registered Nurses for Hospice validation

RN CASE MANAGER- this position is remote but an exception has been provided for the candidate to reside in CA and be a licensed RN in CA.

M-F 8:00 AM- 5:00 PM PST

Job Description:
RN's will be reviewing Hospice related documentation including but not limited to physician orders, Hospice election form and certifications. RN's will be contacting non-par Hospice providers as well as *** of CA members to coordinate care including loading pseudo authorizations into Client's systems. RN's will report suspected fraud waste and abuse.

Must Have Skills:
Hospice background strongly preferred. Health Plan experience preferred.
CA licensed, CA based, Registered nurse.
Must have a minimum of 3 years Hospice experience. Managed Care and Case Management experience strongly preferred.

Day to Day Responsibilities:
Roles will review Hospice documentation including physician orders, Member hospice election form, and certifications.
Roles will also contact Hospice providers and Client members on behalf of the CA Health Plan. If documentation is accurate, the roles will load a pseudo authorization in the CA Health Plan's system. If documentation does not support, Reviewing documentation, contacting hospices and members. Loading pseudo authorizations.

Required Years of Experience: 3-5 years
Required Licensure / Education: CA licensed RN, Located in CA
Comments for Suppliers: will not require additional monitors or a docking station

We are committed to fostering a diverse, inclusive, and equitable workplace where individuals from all backgrounds feel valued and empowered to contribute their unique perspectives. We strongly encourage applications from candidates of all genders, races, ethnicities, abilities, and experiences to join our team and help us build a culture of belonging.

Required profile