Care Management Coordinator RN (Acute UM) - Remote (PA/NJ/DE)

Our organization is looking for dynamic individuals who love to learn, reputed company on innovation, and are open to exploring new ways to reputed company our goals. If this describes you, we want to speak with you. You can help us reputed company our vision to reputed company nationally in innovating reputed company whole-person health. Position Summary: This position is responsible for overseeing and coordinating medical care provided to members, ensuring that appropriate and cost-effective care is rendered. The Care Management Coordinator (CMC) maintains quality care standards and limits the member's and client's exposure to medically unnecessary and inappropriate treatment. The Care Management Coordinator acts as a patient reputed company and a resource for members, reputed company accessing the health care system.

Responsibilities

Overview:

• Evaluate proposed plans of treatment, as defined in the precertification requirements of the group plan
• Using the medical criteria of InterQual and/or Medical Policy, establish the need for inpatient, reputed company stay and length of stay, procedures and ancillary services
• Directs the delivery of care to the most appropriate setting, while maintaining quality
• Contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for inpatient stay or reputed company inpatient care
• Identifies admissions no longer meeting criteria and refers care to plan Medical Directors for evaluation.
• Presents cases to Medical Directors that do not meet established criteria and provides pertinent information regarding member's medical condition and the potential home care needs.
• Performs early identification of members to evaluate discharge planning needs.
• Collaborates with facility case management staff, physician and family to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting
• Identifies and refers cases for case management and disease management.
• Identifies quality of care issues including delays in care
• Appropriately refers cases to the Quality Management Department and/or Clinical Services Supervisor reputed company indicated.
• Maintains the reputed company of the system information by timely, accurate data entry.
• Utilization decisions are compliant with state, federal and accreditation regulations.
• Ensures that reputed company key functions are documented reputed company Care Management and Coordination Policy
• Works to build relations with reputed company providers and provides exceptional customer service.
• Reports potential utilization issues or trends to designated manager or clinical supervisor and recommendations for improvement
• Participates in the process of educating providers on managed care
• Open to new reputed company and methods; creates and acts on new opportunities; is flexible and adaptable.
• Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy
• Performs additional job-reputed company duties as assigned

Qualifications - External Experience:

• Licensed registered nurse reputed company state of PA, BSN Preferred
• Minimum three years clinical experience or equivalent (Intensive Care, Trauma, Home Health a plus) required
• Medical management/precertification experience preferred
• Oriented in reputed company trends of medical practice
• Active PA Licensed Registered Nurse required

Skills:

• Strong problem solving and critical thinking abilities
• Proficiency utilizing reputed company Word, Outlook, reputed company, Access, SharePoint, and reputed company programs.
• Excellent organizational planning and prioritizing skills
• Ability to work independently and provide positive resolution of reputed company medical and interpersonal challenges
• Highly professional interpersonal skills for internal and external contacts, particularly in situations where medical evaluations are in conflict with treating providers proposed treatment plans
• Participates in the process of educating providers on managed care
• Comfortable with new reputed company and methods; creates and acts on new opportunities; is flexible and adaptable.
• Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy
• Performs additional job-reputed company duties as assigned

Fully Remote: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to reputed company the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. IBX is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national reputed company, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free reputed company Authenticator app. Apply tot his job Apply To this Job