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Care Management Nurse
2 months ago
Are you an experienced Registered Nurse with a strong ability to assess intricate medical situations? Do you excel in making pivotal choices that influence patient outcomes? Join GHR Healthcare as a Care Management Nurse and take on a vital role in reviewing and approving necessary healthcare services.
Work Schedule: Monday – Friday (8am – 5pm during standard business hours)
Employment Type: Temp to Hire (Candidates will work remotely but must reside in the tri-state area)
Compensation: Hourly (paid weekly)
Key Responsibilities:
- Clinical Evaluation: Analyze patient medical records to assess the necessity of services based on established criteria.
- Provider Collaboration: Work closely with healthcare professionals to clarify and gather additional clinical data.
- Authorizations: Approve medically essential services and escalate cases that do not meet criteria to the Medical Director.
- Regulatory Compliance & Support: Ensure compliance with healthcare regulations and serve as a resource for members navigating the healthcare landscape.
- Record Keeping: Maintain precise documentation and report trends or issues to enhance the quality of care.
