Care Manager RN
4 weeks ago
Job Summary
This role is responsible for implementing effective utilization management strategies, including reviewing the appropriateness of healthcare services, applying criteria to ensure appropriate resource utilization, identifying opportunities for referral to a Health Coach/case management, and resolving quality issues.
The Care Manager RN will monitor and analyze the delivery of healthcare services, educate providers and members on a proactive basis, and analyze qualitative and quantitative data to develop strategies to improve provider performance/satisfaction and member satisfaction.
The ideal candidate will respond to customer inquiries, offer interventions and/or alternatives, and promote quality and efficiency in the delivery of care management services.
Essential Responsibilities
- Implement care management review processes consistent with established industry and corporate standards.
- Function in accordance with applicable state, federal laws, and regulatory compliance.
- Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
- Promote quality and efficiency in the delivery of care management services.
- Respect the member's right to privacy, sharing only information relevant to the member's care and within the framework of applicable laws.
- Practice within the scope of ethical principles.
- Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
- Employ collaborative interventions that focus, facilitate, and maximize the member's healthcare outcomes.
- Educate professional and facility providers and vendors to streamline and improve processes, while developing network rapport and relationships.
- Develop and sustain positive working relationships with internal and external customers.
- Utilize outcomes data to improve ongoing care management services.
Requirements
- Current RN state licensure required.
- Additional specific state licensure(s) may be required depending on where clinical care is being provided.
- 3 years of related, progressive clinical experience in the area of specialization.
- Experience in a clinical setting.
- Preferred: Experience in UM/CM/QA/Managed Care, WV RN license, Certification in utilization management or a related field.
Skills
- Working knowledge of pertinent regulatory and compliance guidelines and medical policies.
- Ability to multitask and perform in a fast-paced and often intense environment.
- Excellent written and verbal communication skills.
- Ability to analyze data, measure outcomes, and develop action plans.
- Be enthusiastic, innovative, and flexible.
- Be a team player who possesses strong analytical and organizational skills.
- Demonstrated ability to prioritize work demands and meet deadlines.
- Excellent computer and software knowledge and skills.
-
Transitional Care Management Nurse
1 month ago
Charleston, West Virginia, United States Palmetto Primary Care Physicians Full timeAbout Palmetto Primary Care PhysiciansPalmetto Primary Care Physicians (PPCP) is a leading multi-specialty group practice in South Carolina, dedicated to providing exceptional medical care to patients in over 40 offices. With a team of over 100 clinical providers and 500 staff members, PPCP offers a wide range of services, including urgent care, imaging,...
-
Transitional Care Management Registered Nurse
4 weeks ago
Charleston, West Virginia, United States Palmetto Primary Care Physicians Full timeAbout the Role:Palmetto Primary Care Physicians is seeking a skilled Transitional Care Management RN to join our team. As a key member of our multi-disciplinary team, you will play a vital role in ensuring seamless transitions for our patients.Key Responsibilities:Triage patients based on identified goals and perform comprehensive patient assessments.Develop...
-
Transitional Care Management Nurse
4 weeks ago
Charleston, West Virginia, United States Palmetto Primary Care Physicians Full timePalmetto Primary Care Physicians (PPCP) is a leading multi-specialty group practice in South Carolina, dedicated to delivering exceptional medical care to patients across the state.The organization boasts over 100 clinical providers with a wide range of expertise in primary and specialty care, including endocrinology, gastroenterology, neurology, psychiatry,...
-
RN - Case Management Specialist
4 weeks ago
Charleston, West Virginia, United States Trident Medical Center Full timeJob Title: RN - Case Management SpecialistJob Summary:We are seeking an experienced RN - Case Management Specialist to join our team at Trident Medical Center. As a RN - Case Management Specialist, you will be responsible for providing high-quality patient care and managing patient cases with a focus on improving health outcomes.Responsibilities: Provide...
-
Nurse Care Specialist
4 weeks ago
Charleston, West Virginia, United States Agape Care Group Full timeAbout the Role:We are seeking a dedicated and compassionate Registered Nurse to join our team at Agape Care Group. As a Weekend On-Call RN, you will play a vital role in providing high-quality care to our patients and their families.Key Responsibilities:Evaluate patients and create personalized care plansCommunicate effectively with patients, families, and...
-
Travel Nurse RN
4 weeks ago
Charleston, West Virginia, United States Access Health Care Physicians LLC Full timeJob Title: Travel Nurse RN - Progressive Care Unit OpportunityJob Summary:Access Healthcare is seeking a travel nurse RN for a PCU - Progressive Care Unit job in a dynamic healthcare setting. As a travel nurse, you will have the opportunity to work with a talented team of healthcare professionals and provide high-quality patient care.Job Details: Specialty:...
-
Clinical Care Transition Specialist
4 weeks ago
Charleston, West Virginia, United States Option Care Health Full timeJob DescriptionOption Care Health is seeking a highly skilled Clinical Transition Specialist to join our team. As a Clinical Transition Specialist, you will be responsible for educating patients, their families, and facility staff about our services and products. You will also be responsible for assessing patients, gathering preadmission information, and...
-
Travel Nurse RN Case Manager
4 weeks ago
Charleston, West Virginia, United States PHP Full timeJob Title: Travel Nurse RN Case ManagerJob Description:We are seeking a skilled Travel Nurse RN Case Manager to join our team at PHP. As a Travel Nurse RN Case Manager, you will be responsible for providing high-quality patient care and case management services in a rehabilitation setting.Key Responsibilities:Provide patient care and case management services...
-
RN Home Health Case Manager
4 weeks ago
Charleston, West Virginia, United States Amedisys Full timeAbout the Role:We are seeking a highly skilled and compassionate Registered Nurse (RN) to join our team as a Case Manager in homecare. As a RN Home Health Case Manager, you will be responsible for performing patient assessments, collaborating with the care team to develop and implement a plan of care, and promoting patient health and independence through...
-
Travel Nurse RN Case Manager
4 weeks ago
Charleston, West Virginia, United States HealthCare Support Full timeJob Title: Travel Nurse RN Case ManagerJob Summary: We are seeking a skilled Travel Nurse RN Case Manager to join our team at Healthcare Support. As a Travel Nurse RN Case Manager, you will be responsible for providing high-quality patient care and case management services in a travel nursing setting.Responsibilities:Provide patient care and case management...
-
Travel Nurse RN Case Manager
4 weeks ago
Charleston, West Virginia, United States HealthCare Support Full timeJob Title: Travel Nurse RN Case ManagerJob Summary:Healthcare Support is seeking a skilled travel nurse RN case manager to join their team. As a case manager, you will be responsible for coordinating patient care and ensuring seamless transitions between healthcare providers.Key Responsibilities: Coordinate patient care and develop individualized plans of...
-
Hospice RN Case Manager Position
4 weeks ago
Charleston, West Virginia, United States Interim HealthCare Staffing Full timeHospice RN Case Manager Job DescriptionJob Summary: We are seeking a compassionate and skilled Registered Nurse to join our team as a Hospice RN Case Manager. As a Hospice RN Case Manager, you will be responsible for providing exceptional hospice care to patients and families, upholding our high standards of nursing practice.Key Responsibilities:Maintain a...
-
Nurse Care Specialist
4 weeks ago
Charleston, West Virginia, United States Tutera Senior Living & Health Care Full timeJob Title: Registered NurseAt Tutera Senior Living & Health Care, we are seeking a dedicated and compassionate Registered Nurse to join our team. As a Registered Nurse, you will be responsible for ensuring the delivery of efficient and effective nursing care while achieving positive clinical outcomes and resident/family satisfaction in accordance with...
-
Travel Nurse RN Case Management Position
4 weeks ago
Charleston, West Virginia, United States LanceSoft Full timeJob Title: Travel Nurse RN Case Management PositionJob Summary:LanceSoft is seeking a skilled travel nurse RN case management professional to join our team. As a travel nurse RN case management, you will be responsible for providing high-quality patient care and case management services in a dynamic and fast-paced environment.Responsibilities:• Provide...
-
Home Infusion Nurse
4 weeks ago
Charleston, West Virginia, United States Option Care Health Full timeJob Title: Home Infusion Nurse - Care CoordinatorAt Option Care Health, we are seeking a skilled Home Infusion Nurse - Care Coordinator to join our team. As a key member of our clinical staff, you will be responsible for coordinating and providing intermediate direct patient care to patients in the home or in an alternate infusion suite.Key...
-
Managed Care Coordinator II/BH-CM
4 weeks ago
Charleston, West Virginia, United States BlueCross BlueShield of South Carolina Full timeJob SummaryWe are seeking a highly skilled RN Managed Care Coordinator II/BH-CM to join our team at BlueCross BlueShield of South Carolina. In this role, you will be responsible for providing care management interventions to improve care coordination and reduce fragmentation of services. You will work closely with members, healthcare providers, and other...
-
Managed Care Coordinator II/BH-CM
1 month ago
Charleston, West Virginia, United States BlueCross BlueShield of South Carolina Full timeJob SummaryWe are seeking a highly skilled Care Management Specialist II to join our team at BlueCross BlueShield of South Carolina. In this role, you will be responsible for providing active care management, assessing service needs, and developing and coordinating action plans in cooperation with members. You will also evaluate outcomes of plans,...
-
Nurse Care Specialist
4 weeks ago
Charleston, West Virginia, United States Life Care Center of Charleston Full timeWe are seeking a skilled Registered Nurse to join our interdisciplinary team at Life Care Centers of America. As a key member of our healthcare team, you will deliver high-quality nursing care to patients through interpersonal contact and provide services to allow patients to attain or maintain their highest practicable physical, mental, and psychosocial...
-
Travel Nurse RN Position in NICU
4 weeks ago
Charleston, West Virginia, United States MedPro Healthcare Staffing Full timeMedPro Healthcare Staffing is seeking a travel nurse RN for a NICU - Neonatal Intensive Care position in a top healthcare facility.Job Description & RequirementsSpecialty: NICU - Neonatal Intensive CareDiscipline: RNDuration: 13 weeks36 hours per weekShift: 12 hoursEmployment Type: TravelMedPro Healthcare Staffing, a Joint Commission-certified staffing...
-
Critical Care Travel Nurse
1 day ago
Charleston, West Virginia, United States Epic Travel Staffing Full timeEpic Travel Staffing is currently hiring a skilled Travel Nurse to join their team. As a PCU RN, you will be responsible for delivering high-quality patient care in a fast-paced and dynamic environment.Company OverviewEpic Travel Staffing is a leading healthcare staffing agency that provides temporary nursing staff to hospitals across the country. Our...