* Work experience in Microsoft Word, Microsoft Excel and Microsoft Outlook.
* Work experience applying evidence-based criteria (i.e.: MCG, lnterqual); Health plan medical policy / clinical coverage guidelines.
* Clinical Nursing Experience in a hospital or like setting (2 years min)
* Previous Case Management experience
* Previous and or ability to learn use of electronic medical record, UM/CM platforms or electronic health record preferred.
* Knowledge of CMS (Centers for Medicare and Medicaid Services) coverage policies required.
* Current California Registered Nurse license (RN), Licensed Vocational Nurse (LVN) or MSW/LCSW
* Associate's degree (AA) in nursing or equivalent from a two-year college or technical school.
* Bachelor of Science in Nursing, Social Worker or equivalent.
* CCM preferred.
MemorialCare Medical Group is a physician-based organization established to provide advanced comprehensive, effective and efficient health care. With over 30 locations from Long Beach to Dana Point, MemorialCare Medical Group includes more than 250 physicians in the areas of internal medicine, family medicine, pediatrics, geriatric medicine, cardiology, cardio thoracic surgery, gastroenterology, neurology, pulmonology, psychiatry, psychology, rheumatology, sleep medicine and therapeutic acupuncture.
In addition to multiple locations throughout Orange County, MemorialCare Medical Group offers Urgent Care Centers that are open 365 days-a-year, Telephone Advice Nurses available 24 hours-a-day, 7 days-a-week; and lab and digital X-ray services available on-site at most locations.