Basic Qualifications:

Experience

Minimum four (4) years of experience in hospital patient care delivery, OR completion of Masters degree in case management program in lieu of minimum years of experience.

Education

License, Certification, Registration

Additional Requirements:

Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & all other applicable federal/state/local laws & regulations.
Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.
Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day to day operations.
Knowledge of health care benefits associated with various business line (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).
Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.
Bachelors degree in nursing or a health care related field preferred.
Masters degree in case management preferred.

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