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Nurse Care Manager

2 months ago

Reston, Virginia, United States The Jacobson Group Full time

Job Title: RN/Registered Nurse Level 1 – Care Management

Location: Remote (Active New Jersey Registered Nurse License Required)

Job Summary:

The Jacobson Group is seeking an experienced RN/Registered Nurse Level 1 for a remote care management role. This position involves performing nursing duties according to established guidelines to ensure appropriate care levels and planning for transitions across the continuum of care.

Key Responsibilities:

  • Clinical Assessment: Conduct thorough assessments of patients' clinical needs to ensure that their level of care and length of stay are medically appropriate for inpatient care.
  • Service Evaluation: Evaluate the necessity, appropriateness, and efficiency of medical services and procedures to ensure high-quality care.
  • Care Coordination: Assist in the implementation and coordination of care plans for members, ensuring seamless transitions and high-quality care across the continuum.
  • Service Monitoring: Monitor and coordinate services rendered outside the network and local area, negotiate fees, and coordinate with patients, families, physicians, hospitals, and other external parties.
  • Quality of Care: Deliver care supported by clinical practice guidelines, addressing the entire continuum from diagnosis to outcome.
  • Outcome Monitoring: Track and evaluate patients' medical care activities and outcomes for appropriateness and effectiveness.
  • Advocacy: Advocate for members/families to coordinate resource utilization and evaluation of services.
  • Member Engagement: Encourage member participation and compliance with case/disease management programs.
  • Documentation: Accurately document patient information based on standards of practice and organizational policies.
  • Team Interaction: Communicate and collaborate with multidisciplinary teams, both telephonically and in person, to ensure continuity and efficiency of care.
  • Fiscal Accountability: Understand and apply fiscal accountability principles to resource utilization and self-care outcomes.
  • Quality Improvement: Participate in problem-solving, analyzing variances, and quality improvement programs to enhance member outcomes.
  • Additional Duties: Complete other assigned functions as requested by management.

Core Competencies:

  • Customer Focus: Commitment to addressing the needs and concerns of members and families.
  • Accountability: Reliable and responsible in managing care and documentation.
  • Learning: Willingness to continuously learn and adapt to new processes and guidelines.
  • Communication: Effective verbal and written communication skills, with the ability to interact with diverse teams.

Requirements:

Education/Experience:

  • Associate's or Bachelor's degree in Nursing or a health-related field, or an accredited diploma nursing school.
  • Minimum of two (2) years of clinical experience.

Licensing/Certification:

  • Active New Jersey Registered Nurse License.

Knowledge:

  • Proficiency in MS Office (Word, Excel, PowerPoint) and familiarity with intranet and internet applications.
  • Working knowledge of case/care management principles, utilization management, healthcare contracts, benefit eligibility requirements, and hospital structures.

Skills and Abilities:

  • Strong analytical and problem-solving skills.
  • Compassionate interpersonal skills and client relationship management.
  • Excellent judgment, listening, planning, and time management abilities.
  • Effective communication and organizational skills.
  • Tech-savvy with strong computer experience.

Additional Information:

  • Work Hours: Flexible start time with 8-hour shifts, Monday to Friday.
  • Remote Role: Compact multi-state license is acceptable.