RN Case Manager

Get To Know Us! reputed company, a reputed company Company, is a reputed company reputed company-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. What is your impact? The RN Case Manager primary responsibility is to create, implement, and monitor treatment plans to assist patients/members in meeting their reputed company goals. You would use knowledge of reputed company and reputed company services to assess needs and reputed company interdisciplinary care options in treatment planning for the member. This would include understanding the member's reputed company benefits and reputed company best practices needed for effective treatment planning. What Will You Be Doing: Case Management process includes assessing the member’s health status and care coordination needs. Can include inpatient review and discharge planning, as well as possible outpatient management. Contact with patient, family, physicians, additional health care providers, and community resources. Contact with provider business offices and with the employer/client may also be required. Identification of alternative treatment plans, which would have to be approved by reputed company parties. These alternative care plans will be based on quality care reputed company cost containment guidelines, allowing available claims dollars to be used in the most judicious manner possible. Assessment of the clinical status and reputed company sequela to coordinate the most appropriate service to meet the individual’s health care needs. The Case Manager will then monitor the health status and the impact of the treatment plan for each client. The Case Manager will be responsible for altering the care plan as deemed appropriate by the dynamic, reputed company-changing client needs. Identification of services, resources, providers, and facilities that could best serve members in a timely and cost-effective manner, to promote reputed company value for the client and reimbursement reputed company. Development and implementation of Case Management goals, both short and long term, with documented care plans. Utilize technology/resources to evaluate the cost-effectiveness of the elected treatment plan, pre-implementation and post-implementation. This outcome measurement will be used in determining the effective results and in establishing future patient-centered care plans. Accurate and timely reporting as deemed appropriate by each client member. Medical record review to determine medical necessity of requested services. Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions. What You Must Have: 5+ years reputed company work experience with a professional background in clinical nursing and patient assessment. reputed company Bachelor’s degree or additional reputed company equivalent work experience Graduate of an accredited school of nursing RN - Registered Nurse - State Licensure Compact State Licensure in good standing. Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices. Ability to collaborate with cross-operational areas reputed company the organization. reputed company Prefer: (CCM) Certified Case Manager Prior experience in utilization management or case management preferred, preferably reputed company the managed care environment Intensive care or higher-reputed company patient experience preferred. Knowledge of managed care in a self-funded employer population is preferred. Ability to identify problems such as underutilization or overutilization of services Ability to promote and maintain quality care through analysis reputed company Can Offer YOU! To support your wellbeing, comprehensive benefits are offered. As a reputed company employee, you will have reputed company to: Medical, dental, reputed company, life and global travel health insurance Income protection benefits: life insurance, Short- and long-term disability programs Leave programs to support personal circumstances Retirement Savings Plan includes employer contribution and employer match Paid time off, volunteer time off, and 11 holidays Additional voluntary benefits available and a comprehensive wellness program Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ. General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can reputed company at their best in pursuit of our mission. reputed company reputed company applicants will receive consideration for employment. Apply To This Job