RN Case Manager

3 weeks ago

Cincinnati, United States Continuum Medical Staffing Full time
Job DescriptionJob Description

RN Case Manager needed to support managed care provider for onsite position in Cincinatti, OH.  May be willing to take an RN seeking to transition into Case Management if coming from an acute care setting.  '...Provides concurrent and retrospective utilization reviews, large case management, disability case management and other programs to improve the quality of medical care and control costs.  Works with minimal supervision and is responsible to make an established range of decisions, escalating when necessary, and updating manager on a regular basis. Position Responsibilities:

  • Utilizes clinical experience and appropriate clinical criteria and guidelines, along with Plan provisions, in monitoring, evaluating and coordinating both inpatient and outpatient medical care to promote quality outcomes at reasonable costs.
  • Performs prospective and concurrent utilization reviews to determine medical necessity for inpatient admission, inpatient continued stay and selected outpatient services to ensure medically appropriate, high quality and cost effective care and for most efficient utilization of third-party services.
  • Assists members (associates, retirees and dependents) in navigating the healthcare landscape and optimizing benefit plan utilization by identifying opportunities to promote quality healthcare.
  • Monitors potential high-cost claims for early intervention with case management and retrospectively reviews to assure appropriate and cost effectiveness.
  • Communicates regularly with members, physicians, physician office staff, pharmacists and hospital utilization personnel.
  • Conducts and coordinates case management activities for non-occupational Short-Term Disability, return-to-work and Family Medical Leave Act cases.
  • Keeps management and internal physician consultants informed on an ongoing basis of the status of all large case management cases.  Collaborates with management and/or the internal physician consultants on a case-by-case basis.
  • Acts as a source of medical information for Benefits Department.
  • Keeps up-to-date on current medical trends by regularly reviewing journals and professional publications and attending seminars.
  • Documents individual cases for the purposes of cost savings and efficiency analyses and legal record.
  • Maintains compliance with applicable federal and state laws (e.g., HIPAA) related to privacy, security, confidentiality and protection of personal information, including, but not limited to, personal health information and personally identifiable information.
  • Provides support as needed for the Company’s occupational nurse and wellness programs.
  • Performs other duties as assigned by management...'
Company DescriptionContinuum Medical Staffing is a boutique national staffing firm with a big purpose. Our mission and passion is to cultivate talent in the healthcare field and connect exceptional talent with meaningful and rewarding employment opportunities. We help our elite candidates achieve their career goals through personal attention and ongoing support by taking a consultative approach delivering innovative solutions that meet your individual needs. Our clients trust us to develop long-term relationships and continually send them highly qualified talent who exceed their expectations.

Continuum Medical Staffing employs and places healthcare professionals such as Senior Leader Management, Physicians, Physician Assistants, Nurses, Nurse Practitioners, Therapists (PT, OT, SLP), Interim Leadership, Heath Information Managers, Medical Coders and more. Continuum has over 30 years of staffing experience and is recognized as an exceptional leader in the industry. Continuum provides travel / contract assignments, temp to hire placements, or direct hire permanent placements throughout our great nation.Company DescriptionContinuum Medical Staffing is a boutique national staffing firm with a big purpose. Our mission and passion is to cultivate talent in the healthcare field and connect exceptional talent with meaningful and rewarding employment opportunities. We help our elite candidates achieve their career goals through personal attention and ongoing support by taking a consultative approach delivering innovative solutions that meet your individual needs. Our clients trust us to develop long-term relationships and continually send them highly qualified talent who exceed their expectations. \r
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Continuum Medical Staffing employs and places healthcare professionals such as Senior Leader Management, Physicians, Physician Assistants, Nurses, Nurse Practitioners, Therapists (PT, OT, SLP), Interim Leadership, Heath Information Managers, Medical Coders and more. Continuum has over 30 years of staffing experience and is recognized as an exceptional leader in the industry. Continuum provides travel / contract assignments, temp to hire placements, or direct hire permanent placements throughout our great nation.

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