Case Manager RN

A Case Manager RN role is now available Las Vegas, NV! Training will be on site, then you can work remotely. Purpose of Job: Primary responsibility is to provide telephonic triage and nurse advice based on nationally recognized protocols as well as various case management activates to include discharge planning, transitions of care, and utilization management of health plan members. Ensure members receive quality medical care in the most appropriate setting. Major Responsibilities: 1. Perform thorough telephonic nursing assessment and clinical review to determine appropriate triage protocol to utilize for nurse care advice. Ensure member is directed to appropriate level of care at contracted facilities. 2. Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care. 3. Utilize both company and community based resources to establish a safe and effective case management plan for hospitalized members. 4. Collaborate with member, family and health care providers to develop an individualized plan of care that encompasses both acute care episode and post hospital discharge plan. 5. Communicate with all stakeholders the required health related information to ensure quality coordinated care and services are provided expeditiously to all members. 6. Advocate for members and families as needed to ensure the members needs and choices are fully represented and supported by the health care team. 7. Utilize approved clinical criteria to assess and determine appropriate level of care for hospitalized members. 8. Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan. Competencies and Best Practice for High Performers: • Strong organizational and computer skills. • Strong written and oral communication skills. • Good problem solving skills. • Ability to negotiate with professionals, patients and caregivers. • Independent case management knowledge and skills to formulate plans of care without direct supervision preferred. • Ability to contribute to the organizations efforts to eliminate racial and ethnic disparities in organizational performance. Rotating Weekends and Holidays 4 10 hours shifts 10AM-8:30PM Train on site then TelecommuteEqual Opportunity Employer/Veterans/DisabledTo read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to Company will consider qualified applicants with arrest and conviction records

Created: 2021-11-29