Care Manager I - Preservice Review ( Tigard)

Health Net, Inc. (NYSE: HNT) is among the nation’s largest publicly traded managed health care companies. Health Net’s mission is to help people be healthy, secure and comfortable. The company’s POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company’s Web site at www.healthnet.com

 

JOB SUMMARY:  CARE MANAGER I - Preservice Review

The Care Manager I - Preservice Review performs moderately complex case review and first level determination approvals for inpatient, outpatient and ancillary services requests. Reviews include medical appropriateness and medical necessity determinations requiring clinical judgment, independent analysis, critical-thinking skills and detailed knowledge of departmental procedures and clinical guidelines.

REQUIREMENTS:Education:Graduate of an accredited nursing program. Bachelor’s degree preferred.  Certification/License:Valid & active State of Oregon RN License.  Experience:Minimum two years clinical experience. Experience in a Health Plan setting strongly preferred. Knowledge, Skills & Abilities:Strong analytical and problem solving skills preferred. Demonstrated ability for assessment, evaluation and interpretation of medical information. Excellent verbal and written communications skills. Excellent case preparation and abstracting skills. Team player who builds effective working relationships. Ability to work with minimal supervision. Experience using standardized clinical guidelines/criteria required. Strong organizational skills. Able to operate PC-based software programs including proficiency in Word, Excel, PowerPoint, Access and Project. Ability to effectively analyze, interpret, apply and communicate policies, procedures and regulations. 5% Local travel required. ORAny combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.  Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening. Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.