RN Case Manager
42 - 52 USD per hour
Location:United States
Languages:English
Seniority level:Manager, 3-5 years
Experience:3-5 years
Skills:
Communication SkillsAnalytical SkillsCollaborationProblem SolvingMentoringAttention to detailOrganizational skillsDocumentationComplianceCoachingInterpersonal skillsAdaptabilityRelationship buildingCritical thinkingTeamworkResearchClient relationship management
Requirements:
Ability to identify and document member-driven, specific, measurable activities. Self-directed, independent, adaptive, flexible to change, and able to collaborate. Proficient with multiple IT systems. Demonstration of awareness, attitude, knowledge, and skills for diverse populations. 3-5 years relevant experience in clinical health care settings. Utilization Management experience, preferred. Active licensure in Massachusetts is required.
Responsibilities:
Engage members in appropriate plans of care and coordinate services. Interpret and apply case management criteria, processes, policies, and regulatory standards. Review medication lists and educate members with complex pharmacy needs. Connect, engage, and maintain member engagement to support care transitions. Interact with treatment providers to gather clinical information. Monitor clinical quality concerns and escalate issues. Understand member insurance products and benefits.
