Nurse Case Manager
4 days ago
This role is responsible for performing all functions of Utilization Management (UM), Case Management (CM) and Disease Management (DM). The Primary Nurse Coordinator performs concurrent review, discharge planning and care coordination; identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs; promotes quality and cost-effective outcomes; and serves as liaison to physicians and members.
Key Responsibilities- Concurrent review, discharge planning, and care coordination
- Identifying alternate treatment programs
- Consulting with physicians, providers, members, and other resources
- Evaluating options and services to meet individual health needs
- Promoting quality and cost-effective outcomes
- Serving as liaison to physicians and members
- Registered Nurse (RN) with current, valid, unrestricted license in state of operations
- 2 years clinical practice experience of direct clinical care to the customer
- 1 year experience in Condition Management or Case Management in a health insurance, managed care, physician office or hospital setting
- PC proficiency to include Word, Excel, Lotus Notes, and database experience
- Clear and concise verbal and written communication skills
- Knowledge of UM/CM/DM activities and standardized criteria set
- Familiarity of ancillary services including HHC, SNF, Hospice, etc
- Experience in managing complex or catastrophic health cases
- Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)
- Working toward or completion of CCM/CCP/CDE certification or Advanced degree
- Knowledge of medical management policies and procedures
This role is 100% CM and telecommute. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
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