Manage a member's health issues. Identify and resolve barriers that hinder effective care. Ensure patient is progressing towards desired outcomes. Required Skills: Associate and/or Bachelor's degree in Nursing. 3-5 years of clinical acute care experience.
Qualifications for this position include: RN license required. Clinical experience in acute care, or a clinical setting, or case management. Experience/expertise in one of the Company's selected fields of nursing. Knowledge of the insurance industry and claims processing.
Core Responsibilities Include: Reviewing utilization information concerning patient care. Matching those needs to available care options. Managing the transition of Post-Acute Care patients. Must meet the following requirements for consideration:
Implement all care management reviews. Utilize outcomes data to improve ongoing care management services. Qualifications for this position include: RN (Registered Nurse) license. 3-5 years of related, progressive clinical experience. Experience in a clinical setting.
6 months of clinical experience. Clinical RN with current, unrestricted license in PA. 1 year working in managed care or in the insurance industry. Knowledge base of clinical standards of care, preventive health standards. Experience with Medicaid and/or Medicare.
Assess, plan and implement care strategies. Manage the care plan throughout the continuum of care. Required Skills: The ability to travel in assigned region to visit Medicaid members. Current, unrestricted RN license for the state of New York.
Review of appropriateness of healthcare services. Implement effective utilization management strategies. Qualifications for this position include: UM Experience. InterQual experience. 2-5 years' experience in outpatient, home health, or DME. Current DE or Compact State RN License.
A provider of medical managed care services has a current position open for a Telecommute Medical Nurse Case Manager. Candidates will be responsible for the following: Helping coordinate the individual’s treatment program. Ensuring quality, cost-effective care.
Initiating the continuum of care process for neonatal admissions. Interacting telephonically and in writing with hospital staff. Coordinating discharge planning needs for newborns being discharged from intensive care nurseries. Position Requirements Include:
Leading care transition planning process. Participating in discharge planning for Members. Providing support to care coordinators. Position Requirements Include: 1+ years of experience working directly with individuals who meet the MLTSS target population.