…Experience with office medical procedures and treatments and knowledge of insurance, managed care operations, EMR and scheduling software preferred. Additional

…(CCM) Accredited Case Manager (ACM-RN) or UM Certification preferred + Knowledge of managed care and payer environment preferred. This position is represented by

…care of a select patient population as determined by individualized plan of care , clinical pathways, managed care guidelines and contracts. Mobilizes

…+ Two years utilization and/or case management experience inhealthcare regulatory and managed care environments + American Case Management Certification (ACM) or

…with complex psychiatric/substance abuse cases preferred. + Experience in utilization management, managed care or a combination of experience which would provide

…responsible for receiving, reviewing, and processing all incoming Member referrals from the Medi-Cal managed health care plan. The Lead Care Manager will

…healthcare credentialing and compliance. The role involves ensuring providers meet managed care requirements and adhere to California-specific regulations.

…on referral cases to assist in determination of clinical appropriateness for level of care and Medicare/Medicaid and Managed Care related issues 3. Reviews

…to those candidates with previous experience working with the Medicaid population within a Managed Care Organization (MCO). Mileage is reimbursed as part of our

…Rate: $20.00 Position Summary: Full-time Community Resource Navigator position available for our Managed Care Department in Vancouver, WA. The role of the