Care Management Coordinator RN
4 weeks ago
Care Management Coordinator RN (remote) - 240335 DESCRIPTION/RESPONSIBILITIES: Job Summary The Care Management Coordinator primary responsibility is to evaluate a member's clinical condition through the review of medical records (including medical history and treatment records) to determine the medical necessity for patient's services based on advanced knowledge and independent analysis of those medical records and application of appropriate medical necessity criteria. If necessary, the Care Management Coordinator directly interact with providers to obtain additional clinical information. The Care Management Coordinator has the authority to commit the company financially by independently authorizing services determined to be medically necessary based on their personal review. For those cases that do not meet established criteria, the Care Management Coordinator provides relevant information regarding members medical condition to the Medical Director for their further review and evaluation. The Care Management Coordinator has the authority to approve but cannot deny the care for patients. The Care Management Coordinator is also responsible for maintaining regulatory compliance with federal, state and accreditation regulations. Additionally, the Care Management Coordinator acts a patient advocate and a resource for members when accessing and navigating the health care system. Key Responsibilities * Applies critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determination. Utilizes resources such as; InterQual, Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan. * Utilizes the medical criteria of InterQual and/or Medical Policy to establish the need for inpatient, continued stay and length of stay, procedures and ancillary services. * Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services. * Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or continued stay, clarifying medical information with provider if needed. * Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination * Performs early identification of members to evaluate discharge planning needs. * Collaborates with case management staff or physician to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting. * Reports potential utilization issues or trends to designated manager and recommendations for improvement. * Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care. * Appropriately refers cases to Case and Disease Management. * Ensures request is covered within the member's benefit plan. * Ensures utilization decisions are compliant with state, federal and accreditation regulations. * Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests. * Ensures that all key functions are documented via Care Management and Coordination Policy. * Maintains the integrity of the system information by timely, accurate data entry. * Performs additional duties assigned. Qualifications Education Active PA Licensed RN BSN Preferred Experience Minimum of three (3) years of acute care clinical experience in a hospital or other health care setting. Prior discharge planning and/or utilization management experience is desirable. Medical management/precertification experience preferred. Knowledge, & Skills * Exceptional communication, problem solving, and interpersonal skills. * Action oriented with strong ability to set priorities and btain results. * Team Player - builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy. * Open to change, comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable. * Embrace the diversity of our workforce and show respect for our colleagues internally and externally. * Excellent organizational planning and prioritizing skills. * Ability to effectively utilize time management. * Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs. Ability to learn new systems as technology advances. REQUIRED SKILLS: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. Equal Opportunity Employer-minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
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Care Coordinator
1 week ago
Philadelphia, United States Always Best Care Senior Service Full timeThe Always Best Care's Care Coordinator (CC) position is responsible for coordinating the care delivery for Always Best Care homecare/non-medical clients. The CC is responsible for teaching, coaching, and supporting the Direct Care Worker (DCW) to ensure the client’s specific care delivery is provided. The goal of this position is to enhance the client’s...
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Care Coordinator
1 week ago
Philadelphia, United States Always Best Care Senior Service Full timeThe Always Best Care's Care Coordinator (CC) position is responsible for coordinating the care delivery for Always Best Care homecare/non-medical clients. The CC is responsible for teaching, coaching, and supporting the Direct Care Worker (DCW) to ensure the client’s specific care delivery is provided. The goal of this position is to enhance the client’s...
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Care Coordinator
2 days ago
Philadelphia, United States Always Best Care Senior Service Full timeThe Always Best Care's Care Coordinator (CC) position is responsible for coordinating the care delivery for Always Best Care homecare/non-medical clients. The CC is responsible for teaching, coaching, and supporting the Direct Care Worker (DCW) to ensure the client’s specific care delivery is provided. The goal of this position is to enhance the client’s...
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Care Coordinator
2 weeks ago
Philadelphia, United States Always Best Care Senior Services - Philly, Lower Bucks & Delaware Counties, and Main Line Area Full timeThe Always Best Care's Care Coordinator (CC) position is responsible for coordinating the care delivery for Always Best Care homecare/non-medical clients. The CC is responsible for teaching, coaching, and supporting the Direct Care Worker (DCW) to ensure the client’s specific care delivery is provided. The goal of this position is to enhance the client’s...
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Registered Nurse Care Manager
2 weeks ago
Philadelphia, United States Public Health Management Corporation Full timeRegistered Nurse Care ManagerPHMC is proud to be a leader in public health. PHMC requires that all employees are fully vaccinated with the Covid-19 vaccine before the first day of employment. Job Description: Provide primary care to adults in community-based nurse-managed health center to diverse and underserved populations. Nurse Care Manager reports to...
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Registered Nurse Care Manager
2 days ago
Philadelphia, United States Public Health Management Corporation Full timeRegistered Nurse Care ManagerPHMC is proud to be a leader in public health. PHMC requires that all employees are fully vaccinated with the Covid-19 vaccine before the first day of employment. Job Description: Provide primary care to adults in community-based nurse-managed health center to diverse and underserved populations. Nurse Care Manager reports to...
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Care Manager
1 month ago
Philadelphia, United States YM Staffing Solution Full timeJob DescriptionJob DescriptionWe are looking for RN's that have 2 years of experience in the following. This will be a full-time position. You will be traveling to patients' homes. • Dialysis Care• Home Health Care • Hospice • Case Management (CM)1) Develop and continually adapt an individualized care plan in conjunction with Monogram...
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Care Manager
21 hours ago
Philadelphia, United States YM Staffing Solution Full timeJob DescriptionJob DescriptionWe are looking for RN's that have 2 years of experience in the following. This will be a full-time position. You will be traveling to patients' homes. • Dialysis Care• Home Health Care • Hospice • Case Management (CM)1) Develop and continually adapt an individualized care plan in conjunction with Monogram...
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Behavioral Health Care Management Coordinator
2 weeks ago
Philadelphia, United States IntePros Full timeIntepros seeks a Behavioral Health Care Management Coordinator to collaborate with one of our healthcare clients remotely. While the position is remote, candidates must reside in the tri-state area (PA, NJ, DE).Job Summary:The primary responsibility of the Behavioral Health (BH) Care Management Coordinator is to assess a member's BH condition by reviewing...
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Philadelphia, United States IntePros Full timeIntepros seeks a Behavioral Health Care Management Coordinator to collaborate with one of our healthcare clients remotely. While the position is remote, candidates must reside in the tri-state area (PA, NJ, DE).Job Summary:The primary responsibility of the Behavioral Health (BH) Care Management Coordinator is to assess a member's BH condition by reviewing...
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RN Care Manager
2 days ago
Philadelphia, Pennsylvania, United States Strive Health Full timeRN Care Manager - Philadelphia, PAWhat We Strive For Strive Health is built for purpose - to transform a broken kidney care system.We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive's model is driven by a high-touch care team that integrates with local...
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Registered Nurse Care Manager
2 weeks ago
Philadelphia, PA, United States Public Health Management Corporation Full timeRegistered Nurse Care Manager PHMC is proud to be a leader in public health. PHMC requires that all employees are fully vaccinated with the Covid-19 vaccine before the first day of employment. Job Description: Provide primary care to adults in community-based nurse-managed health center to diverse and underserved populations. Nurse Care Manager reports to...
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Registered Nurse Care Manager
2 weeks ago
Philadelphia, PA, United States Public Health Management Corporation Full timeRegistered Nurse Care Manager PHMC is proud to be a leader in public health. PHMC requires that all employees are fully vaccinated with the Covid-19 vaccine before the first day of employment. Provide primary care to adults in community-based nurse-managed health center to diverse and underserved populations. Nurse Care Manager reports to the Clinical...
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RN Care Manager
6 days ago
Philadelphia, United States Strive Health Full timeRN Care Manager - Philadelphia, PAWhat We Strive For Strive Health is built for purpose - to transform a broken kidney care system. We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive's model is driven by a high-touch care team that integrates with local...
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RN Care Manager
2 days ago
Philadelphia, United States Strive Health Full timeRN Care Manager - Philadelphia, PAWhat We Strive For Strive Health is built for purpose - to transform a broken kidney care system. We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive's model is driven by a high-touch care team that integrates with local...
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Philadelphia, United States IntePros Full timeIntepros seeks a Behavioral Health Care Management Coordinator to collaborate with one of our healthcare clients remotely. While the position is remote, candidates must reside in the tri-state area (PA, NJ, DE).Job Summary:The primary responsibility of the Behavioral Health (BH) Care Management Coordinator is to assess a member's BH condition by reviewing...
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Mds Coordinator, Rn
5 days ago
Philadelphia, United States Long Term Health Care Facility Full time**_MDS Coordinator_** **_ $$15,000 Sign on bonus!!!_** Our skilled nursing facility provides traditional nursing home care as well as sub-acute rehabilitation, hospice, respite, and Alzheimer’s care. Our goal is to achieve the highest practicable physical, mental, and psychological well-being while treating each resident with the utmost dignity and...
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RN Care Manager
2 days ago
Philadelphia, United States Strive Health Full timeRN Care Manager - Philadelphia, PA What We Strive For Strive Health is built for purpose - to transform a broken kidney care system. We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive's model is driven by a high-touch care team that integrates with local...
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RN Care Manager
12 hours ago
Philadelphia, United States Strive Health Full timeRN Care Manager - Philadelphia, PA What We Strive For Strive Health is built for purpose - to transform a broken kidney care system. We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive's model is driven by a high-touch care team that integrates with local...
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Patient Care Coordinator
2 weeks ago
Philadelphia, United States All American Home Care LLC Full timeAll American Home Care LLC is an EEO employer - M/F/Vets/Disabled JOIN THE WINNING TEAM! ALL AMERICAN HOME CARE offers an excellent benefit package that includes generous paid time off, paid holidays, healthcare benefits (Health, Vision, and Dental), Life insurance and 401K. JOB SUMMARY: • Providing coordinated care to patients by developing, monitoring,...
