A healthcare company is in need of a Telecommuting Registered Nurse Clinical Care Advisor. Core Responsibilities Include: Leveraging clinical expertise and critical thinking skills to help millions achieve optimal health.
Ensuring process compliance with case handling, appropriate discharge planning, and/or case management from the acute care setting and post-acute setting. Providing primary input to hiring, firing, promotion, performance and rewards decisions for direct reports.
A managed care company has a current position open for a Telecommute RN Transition Care Coach in the Spartanburg Area. Individual must be able to fulfill the following responsibilities: Coordinate care and reassess member's needs.
Graduate of an accredited school of nursing. Active unrestricted RN license in the State of Arizona. Clinical experience in medical/surgical or specialty care. Knowledge of managed care delivery systems. Knowledge of quality improvement.
Providing site of service solutions to patients seeking care at non-preferred treatment sites. Providing member with resources to optimize their treatment outcomes. Supporting clinical services such as the appeals program. Skills and Requirements Include: Bachelors: Nursing (Required)
Coordinating the delivery of high quality, cost-effective care based on a customized model of care. Advocating for the member/patient and family among various sites to coordinate resource utilization. Encouraging client/member/patient participation and compliance in the clinical program efforts.
Evaluating the pre-service authorization request. Promoting the quality cost-effectiveness of medical care. Forwarding requests to the appropriate physician or medical director with recommendations for other determinations. Qualifications for this position include:
Collaborating effectively with an interdisciplinary team to establish an individualized plan of care for members. Coordinating member visits with providers and specialists as needed. Administering all provider resources through the care continuum.
Provide a complete continuum of quality care through close communication with members. Support members with condition education, medication reviews and connections to resources. Qualifications Include: 25-50% travel. Current, unrestricted RN license. Access to reliable transportation.
Manage network participation, care with specialty networks, care with providers and transfers to alternative levels of care. Examine clinical programs information to identify members for specific case management. Qualifications Include: