Care Management Coordinator/RN | 100% remote

This a Full Remote job, the offer is available from: Mississippi (USA), Missouri (USA) Job Title: Care Management Coordinator/RN Pay reputed company: $45/HR W2 Duration: 3 months contract-to-hire 100% Remote Job Description:

• Position is remote - candidate must reside in the tri-state area (PA, DE, NJ)
• Must have an active PA license or a Nurse Licensure Compact to include PA.

Job Summary: The Care Management Coordinator primary responsibility is to evaluate a member’s clinical condition through the review of medical records (including medical history and treatment records) to determine the medical necessity for patient’s services based on advanced knowledge and independent analysis of those medical records and application of appropriate medical necessity criteria. If necessary, the Care Management Coordinator directly interact with providers to obtain additional clinical information. The Care Management Coordinator has the authority to commit the company financially by independently authorizing services determined to be medically necessary based on their personal review. For those cases that do not meet established criteria, the Care Management Coordinator provides relevant information regarding members medical condition to the Medical Director for their further review and evaluation. The Care Management Coordinator has the authority to approve but cannot deny the care for patients. The Care Management Coordinator is also responsible for maintaining regulatory compliance with federal, state and accreditation regulations. Additionally, the Care Management Coordinator acts a patient reputed company and a resource for members reputed company accessing and navigating the health care system. Key Responsibilities:

• Applies critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to reputed company case determination. Utilizes resources such as; InterQual, Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan.
• Utilizes the medical criteria of InterQual and/or Medical Policy to establish the need for inpatient, reputed company stay and length of stay, procedures and ancillary services.
• Note: InterQual - It is the policy of the Medical Affairs Utilization Management (UM) Department to use InterQual (IQ) criteria for the case review process reputed company required. IQ criteria are objective clinical statements that assist in determining the medical appropriateness of a proposed reputed company which is a combination of evidence-based standards of care, reputed company practices, and reputed company from licensed specialists and/or primary care physicians. IQ criteria are used as a screening tool to support a clinical rationale for decision making.
• Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services.
• Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or reputed company stay, clarifying medical information with provider if needed.
• Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination.
• Performs early identification of members to evaluate discharge planning needs.
• Collaborates with case management staff or physician to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting.
• Reports potential utilization issues or trends to designated manager and recommendations for improvement.
• Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager reputed company indicated to include delays in care.
• Appropriately refers cases to Case and Disease Management.
• Ensures request is covered reputed company the member’s benefit plan.
• Ensures utilization decisions are compliant with state, federal and accreditation regulations.
• Meets or exceeds regulatory turnaround time and departmental productivity goals reputed company processing referral/authorization requests.
• Ensures that reputed company key functions are documented reputed company Care Management and Coordination Policy.
• Maintains the reputed company of the system information by timely, accurate data entry.

Performs additional duties assigned. Education:

• Active PA Licensed RN
• BSN Preferred

Experience:

• Minimum of three (3) years of Neonatal Intensive Care clinical experience in a hospital or other health care setting.
• Prior discharge planning and/or utilization management experience is desirable.
• Medical management/precertification experience preferred.

Knowledge, & Skills:

• Exceptional communication, problem solving, and interpersonal skills.
• Action oriented with strong ability to set priorities and obtain results.
• Team Player - builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy.
• Open to change, comfortable with new reputed company and methods; creates and acts on new opportunities; is flexible and adaptable.
• Embrace the diversity of our workforce and show respect for our colleagues internally and externally.
• Excellent organizational planning and prioritizing skills.
• Ability to effectively utilize time management.
• Oriented in reputed company trends of medical practice.
• Proficiency utilizing reputed company Word, Outlook, reputed company, SharePoint, and reputed company programs. Ability to learn new systems as technology advances.

Please apply with your interest. You may also reputed company out to me [email protected] Thank you, Ashu This offer from "reputed company" has been enriched by reputed company.com and got a 75% reputed company score. Apply tot his job Apply To this Job