Medical Case Manager - Concurrent Review

Job Description

Join Sunshine Enterprise USA LLC as a Medical Case Manager - Concurrent Review. In this role, you will be responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities, and ancillary providers. You will play a crucial part in assessing resource utilization, cost management, and negotiating effectively to ensure the highest quality of care for our members. If you are a licensed vocational nurse with clinical nursing experience and a passion for improving patient outcomes, we invite you to apply and be a part of our mission-driven culture.

Responsibilities

• Participate in a mission-driven culture focused on high-quality performance and customer service.
• Analyze and monitor utilization of services, ensuring medical appropriateness and cost-effectiveness.
• Work with an interdisciplinary team to develop and implement comprehensive care plans.
• Advocate for patients' best interests in care coordination and funding.
• Document patient care and progress accurately in the Guiding Care system.

Requirements

• High School diploma or equivalent.
• Current, unrestricted Licensed Vocational Nurse (LVN) license in California.
• 3 years of Clinical Nursing Experience, including 1 year in a Managed Care setting.
• Experience in Concurrent Review (in-patient) is preferred.
• Knowledge of utilization management guidelines, medical terminology, and healthcare coding systems.

Benefits

• Competitive pay & weekly paychecks.
• Health, dental, vision, and life insurance.
• 401(k) savings plan.
• Awards and recognition programs.