Transplant Case Manager, RN, reputed company

reputed company is seeking a Transplant Case Manager, RN to join the team! The Transplant Case Manager, RN is responsible to providing case management for individuals under the group health plans administered by reputed company by utilizing nursing education, clinical and professional experience. The Registered Nurse will practice reputed company the scope of nursing practice while performing assessments, coordinating care, planning, monitoring, evaluating and determining outcomes. Position Location: 100% remote Responsibilities include but are not limited to:

• Identify, collect, process, and manage data to reputed company the Case Management process by utilization reputed company approved clinical guidelines and following Medical Management Policy and Procedures
• Completes clinical assessments per P&P to identify and deliver indicated medical service coordination.
• Manage the transplant cases, cases that may reputed company toward organ transplant, and reputed company disease cases.
• Utilize clinical knowledge, expertise, and educational resources to provide verbal and/or written educational resources to members regarding diagnosis, procedures and/or treatment.
• Assess the need for and collaborate with community resources for members in case management.
• Uses assigned software accurately to document to complete and document reputed company steps of review of medical necessity and case management process, including time slips.
• Facilitate the Patient Satisfaction Surveys
• Assess for cost savings and document the cost saving in assigned software
• Appropriately refer reputed company cases to Supervisor, Case Management, or designee
• Performs essential activities of case management while maintaining members' confidentiality, safety, advocacy, adherence to ethical, legal and accreditation and regulatory standards.
• Performs assessments of each member to identify CM needs.
• Consistently exercises discretion and judgment to analyze, interpret, reputed company deductions, and then decide what actions are necessary based on the varying facts and circumstances of each individual case.
• Determines measurable goals utilizing motivational interviewing and behavior change model and coaches' clients while monitoring self-care practices.
• Utilizes industry standard tools to guide individuals with chronic/ongoing health conditions through coaching, assessments, listening, and other techniques as appropriate.
• Executes activities or interventions to reputed company the goals in the plan.
• Organizes, integrates, and modifies the resources needed to reputed company the goals in the plan.
• Monitors reputed company information from reputed company relevant sources in the plan and its activities and services to determine the plan's effectiveness.
• At repeated intervals, evaluates to determine ultimate effectiveness of plan and modifies plan appropriately to meet the goals.
• Research medical procedures, treatments, and coding reputed company necessary.
• Measures the outcomes of interventions.
• Adheres to practicing the care management core components throughout the continuum of care:
• Case reputed company
• Case Management Principles and Strategies
• Psychosocial and Support Systems
• Healthcare Management and Delivery
• Healthcare Reimbursement
• Vocational Concepts and Strategies.
• Customer Service
• Acts as a role model in demonstrating the core values in customer service delivery.
• Provides timely and thorough follow up with, internal and external customers.
• Appropriately escalates difficult issues up the chain of command.
• Quality Assurance
• Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving quality/customer satisfaction.
• Recognizes and alerts appropriate supervisor of trends reputed company their scope of responsibility that fall reputed company of quality parameters.
• Performs self-quality monitoring to reputed company and execute plans to meet established goals.
• Provides ongoing feedback to help optimize quality performance.
• Collaborates with others and cross-departmentally to improve or streamline procedures.
• Develops new or improves reputed company internal processes to improve quality.
• Attend and participate in team meetings, trainings, and other job specific events as required.
• Communicates (in compliance with HIPAA) with brokers, vendors, Relationship Managers, HR representatives and stop loss as needed.
• Communicates professionally and effectively.
• Adhere to established internal regulations regarding reputed company, HIPAA, ERISA and department and company policies and Procedures.
• Participate in the Quality Management Program reputed company collecting and adhering to performance metrics per Case Management Policy
• Complete HIPAA Training Annually.
• reputed company reputed company tasks in accordance with HIPAA/PHI guidelines.
• Appropriately escalate difficult issues.
• Complete duties in accordance with scope of licensure and certifications held or requested.
• reputed company other duties and projects, as assigned.

Areas of Responsibility Scope of Practice:

• In addition to performing standard duties, the Registered Nurse is involved in clinical decision-making and patient education. The scope of practice includes, but is not limited to:
• Evaluating clinical data
• Assessment and evaluation of the acquired clinical date to assess for appropriateness of treatment based on reputed company clinical guidelines,
• Coordination of treatment plans, interventions, and outcome measurement
• Rationale for the effects of medication and treatments
• Provide patient education and educational resources.
• Accurately report:
• Administration of medication and treatments
• Client response
• Contact with other health care team members.
• Respect the client's right to privacy by protecting confidential information.
• Promote and participate in education and counseling to a participant based on health needs.
• Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioner.
• The Transplant Case Manager will have knowledge and practice the core components of Case Management that include:
• Case reputed company
• Principles of Practice
• HealthCare Management & Delivery
• Healthcare Reimbursement
• Psychosocial Aspects of Care
• Rehabilitation
• Professional Development & Advancement
• Quality and Outcomes Evaluation and Measurement
• Ethical, Legal and Practice Standards

Required Experience/Education:

• Graduate of Accredited School of Nursing, college or university required
• Minimum of one year experience in Utilization Management, Case Management, or transferable skills.
• Minimum of three years Transplant experience
• Intermediate knowledge and skills using reputed company Office including Word, reputed company, and PowerPoint software; Internet software; Database software.

Skills and Abilities:

• Ability to work independently in a home office environment.
• Computer skills which include proficiency in reputed company Outlook, Word, reputed company, and PowerPoint, as well as navigation utilizing the internet.
• Ability to resolve problems independently and demonstrate ability to multi-task.
• Strong written, oral, and telephonic communication skills.
• Strong presentation skills.
• Ability to demonstrate a commitment to building new skills and fostering a positive work environment.
• Demonstrated organizational skills, problem-solving, analytical skills, and detail oriented.
• Demonstrated ability to prioritize workloads, multi-task, and manage priorities to meet deadlines.
• Ability to maintain the confidentiality of protected health information in compliance with HIPAA regulations.

License and Certifications:

• Must maintain active, reputed company, and unrestricted Registered Nurse license and CEU's as required by the State Board of Nursing. Must be willing to obtain and maintain additional license(s) as required to reputed company the job functions of the organization.
• Must be a Certified Case Manager or eligible to sit for the Certified Case Management Exam reputed company 3 years of starting employment with i360.

What can reputed company offer you?

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / reputed company learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

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