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Field Case Manager

2 months ago

Winchester, Virginia, United States A-Line Staffing Solutions Full time
Position Overview

A-Line Staffing Solutions is seeking a dedicated Registered Nurse Field Case Manager. This role involves collaborating with a prominent organization, offering significant opportunities for professional advancement. The position is full-time, requiring over 40 hours per week.

Compensation and Benefits

  • The hourly wage for this role is $40.84.
  • Comprehensive benefits are available to full-time employees after a specified period of employment.
  • A 401(k) plan with company matching is accessible to full-time employees after one year of service.

Key Highlights

  • This role is a contract position with the potential for permanent employment based on attendance, performance, and organizational needs.
  • Availability is required Monday through Friday from 8:00 AM to 5:00 PM.
  • Traveling up to 75% of the time is necessary for this position.

Core Responsibilities

  • Conduct assessments, planning, implementation, and coordination of case management activities through telephonic and in-person interactions to evaluate members' medical needs and promote overall wellness.
  • Develop proactive strategies to address identified issues, enhancing both short and long-term outcomes while improving members' overall wellness through integrated care.
  • Utilize clinical tools and data analysis to assess members' needs and eligibility for benefits, facilitating smooth transitions to organizational programs.
  • Apply clinical judgment to develop strategies aimed at reducing risk factors and addressing complex health and social determinants impacting care planning.
  • Review previous claims to evaluate their potential impact on current case management and eligibility.
  • Employ a holistic approach to assess the need for referrals to clinical resources for functionality determination.
  • Collaborate with supervisors and multidisciplinary teams to overcome barriers and achieve goals, presenting cases at conferences for comprehensive claim management.
  • Adhere to case management processes in compliance with regulatory and organizational policies.
  • Determine medical necessity and appropriateness of care.
  • Facilitate optimal health outcomes for members.
  • Identify opportunities for continuous quality improvement and compliance.
  • Educate and empower members to ensure satisfaction and promote advocacy.
  • Optimize overall costs associated with care.
  • Implement and evaluate policies based on program directives.
  • Foster decision-making capabilities among colleagues at all levels.

Qualifications

  • High School Diploma or equivalent.
  • Mandatory attendance during the initial training period.
  • Current Registered Nurse License.
  • A minimum of three years of clinical experience in medical-surgical or behavioral health settings.
  • Experience in managed care is preferred.
  • Valid driver's license.

Preferred Qualifications

  • Experience in case management within an integrated care model is highly desirable.

This position offers a unique opportunity for qualified candidates to contribute to a dynamic healthcare environment.