Job Description: 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 Molina Healthcare of CA members to coordinate care including loading pseudo authorizations into 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 Molina 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