RN Case Managers

Minimum of recent 2 years combined case management or clinical experience providing direct patient care and utilization review/case management experience in an acute care environment Working knowledge in the use of InterQual, Meditech, Medicare or other medical management guidelines.Knowledge of legislative requirements, NCQA guidelines and health plan delegation requirements for utilization management.Thorough knowledge of health care industry, benefit interpretation, professional/facility reimbursement methodologies, contracts and flow of related information.Must have strong problem solving skills. Ability to analyze problems and formulate plans, solutions and a course of action.Ability to multi-task, meet deadlines and maintain department production and quality standards.Proficient computer skills including Microsoft Excel and Word. Competence in navigating the internet.Substantial working knowledge of utilization review/referral processing systems (i.e. EZ Cap, Diamond, IDX).Excellent interpersonal, verbal and written communication skills. Ability to articulate clinical and non-clinical information to individuals of all levels of understanding