Registered Nurse - Telephonic Hospice Validations (Remote)

Job Title: Remote Hospice Telephonic Case Manager (Temp-to-Perm)

Pay Rate: Up to $45/hr

Schedule: Monday – Friday, 8:00 AM – 5:00 PM PST

Location: Remote, but candidate must reside in California and hold a valid CA RN license

Job Description

A Managed Care Organization is seeking experienced Registered Nurses to serve as telephonic case managers for hospice validation. The primary responsibility of this role is to review hospice-related documentation, including but not limited to physician orders, hospice election forms, and certifications. The RN will coordinate care by contacting non-par hospice providers and managed care members and will enter pseudo authorizations into the health plan’s system. Additionally, the RN will be responsible for identifying and reporting suspected fraud, waste, and abuse.

Key Responsibilities

• Review and validate hospice documentation, including physician orders, hospice election forms, and certifications.
• Contact hospice providers and members to verify and coordinate care.
• Enter pseudo authorizations into the managed care system.
• Report suspected fraud, waste, and abuse as necessary.
• Ensure compliance with all policies and regulatory guidelines.
  
  

Required Skills & Qualifications

• Active Registered Nurse (RN) license in the state of California.
• Candidate must be located in California.
• Minimum of 3 years of hospice experience.
• Managed care and case management experience strongly preferred.
• Strong understanding of hospice regulations and documentation requirements.
• Excellent communication skills for interacting with providers and members telephonically.
• Ability to work independently and efficiently in a remote environment.
  
  

Preferred Experience

• Previous experience working in a health plan or managed care organization.
• Familiarity with authorization processing and healthcare systems.