Nurse Case Manager

3 days ago


Wheeling, West Virginia, United States The Health Plan of West Virginia Inc Full time
Nurse Navigator Job Summary:

We are seeking an experienced Nurse Navigator to join our team at The Health Plan of West Virginia Inc. As a key member of our clinical team, you will play a critical role in ensuring that our members receive high-quality, patient-centered care. Your primary responsibility will be to navigate and advocate for identified members who require coordinated care and integration. You will also investigate missed admissions, determine appropriateness of admission and continued stay, and refer admissions/continued stays with questionable medical necessity to the Medical Director.

Responsibilities:
  • Investigate missed admissions and obtain pertinent details.
  • Determine appropriateness of admission and continued stay using established clinical criteria.
  • Referral admissions/continued stays with questionable medical necessity to the Medical Director.

Requirements:
  • Active Ohio and WV licensure as a Registered Nurse with at least five (5) years experience.
  • Prior experience in Utilization Management, Quality Improvement, Case Management, Disease Management, or Managed Care is highly desirable.

Estimated Salary:$95,000 - $125,000 per year, based on experience.
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