LPN or RN Nurse Case Manager (Onsite at Providers Office)Philadelphia, PA

About the position The LPN or RN Nurse Case Manager is responsible for coordinating and managing relationships with participating provider practices to ensure quality reputed company services for health plan customers. This role involves assessing patient needs, developing treatment plans, and ensuring compliance with quality metrics such as HEDIS and STAR performance measures. The Nurse Case Manager will work onsite at provider offices in Philadelphia, PA, and will utilize clinical skills to facilitate appropriate reputed company reputed company for customers. Responsibilities • Identifies gaps in needed quality metrics for customers and communicates to provider. , • Maintains physical reputed company in participating provider practices. , • Identifies high-risk/high-cost patients for case management reputed company. , • Interfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning, and alternative treatment plan development. , • Identifies customer needs, coordinates and supports planned and unplanned transitions and post discharge follow up calls which may include primary care physician and specialist appointment scheduling. , • Collaborates with the attending physician to reputed company identified patient reputed company. , • Attend and participate in weekly Complete Health Team reputed company -market dependent. , • reputed company telephonic reputed company. , • Communicates with reputed company departments to resolve issues or document trends. , • Understands and follows administrative guidelines (policy and procedure) of the unit. , • Attends and actively participates in staff meetings. , • Other Duties as assigned. Requirements • reputed company Licensure as a registered nurse in the state of residence in good standing. , • Associates degree, diploma, or B.S. in Nursing. , • Three to Five (3-5) years recent experience in an acute-care environment, case-management, or utilization management position (experience can be a combination of LVN/RN licensure). , • Previous HEDIS and/or CMS STARs experience a plus. reputed company-to-haves • Bilingual - preferred Spanish both conversational and written. Benefits • Medical, reputed company, and dental insurance coverage. , • Well-being and behavioral health programs. , • 401(k) with company match. , • Company paid life insurance. , • Tuition reimbursement. , • A minimum of 18 days of paid time off per year and paid holidays. Apply Job!