Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
1 POS: RICHMOND, VA
1 POS: MECHANICSVILLE, VA
1 POS: EMPORIA, VA
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues
Determines medical necessity/ appropriateness Facilitates optimal outcomes Identifies and follow through with continuous quality/ compliance opportunities . May also include identification of aberrance's and initiation of corrective action Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy Optimize total costs Implementation and evaluation of policy based on usage and program directives Educate/empower colleagues at all levels to enable decision making at most appropriate level
Qualifications:
- Case Management in an integrated model preferred
- 5 years clinical practice experience
- RN with current unrestricted VA state licensure required.
Shift: M-F 8am-5pm
Job period: 02/13/2023 to 04/28/2023
Work Set-up: Remote with future possibility of onsite
