Registered Nurse Managed Care Case Manager
Location: Newark Delaware
Description: Pathway Medical Staffing is employing Registered Nurse Managed Care Case Manager right now, this occupation will be placed in Delaware. Further informations about this occupation opportunity kindly read the description below. One of the fastest growing insurers in the nation is looking for a Registered Nurse Managed Care Case Manager to join their team for a long-term temporary opportunity.
In this position you will:
Assess patient’s clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay
Evaluate the necessity, appropriateness, and efficiency of medical services and procedures provided
Coordinate and assist in implementation of plan for members
Monitor and coordinate services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate
Coordinate with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome
Coordinate the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care
Monitor patient’s medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness
Advocate for the member and family among various sites to coordinate resource utilization and evaluation of services provided
Encourage member participation and compliance in the case/disease management program efforts
Document accurately and comprehensively based on the standards of practice and current organization policies
Interact and communicate with multidisciplinary teams either telephonically and/or on site striving for continuity and efficiency as the member is managed along the continuum of care
Understand fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes
Evaluate care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes
Requirements
Please be advised that we are only considering nurses with the following:
Current RN Licensure in Delaware
Minimum 2 years experience performing utilization management and prior authorization in a managed care setting
Minimum 2 years clinical nursing experience in an acute care setting
Experience using guidelines such as Milliman and InterQual to ensure appropriate level of care and transition planning
Managed care case management experience
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Pathway Medical Staffing.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Fri, 17 Aug 2012 01:06:39 GMT