RN Case Manager – Transition of Care (Outpatient)
New
A
Alignment HealthHealthcare
United StatesFull-TimeManager
Salary79,697 - 119,545 USD per year
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Job Details
- Experience
- Minimum 5 years of clinical case management experience; or any combination of education and experience, which would provide an equivalent background.
- Required Skills
- Problem SolvingOrganizational skillsTime ManagementWritten communication
Requirements
- Have at least 5 years of clinical case management experience, or an equivalent combination of education and experience.
- Hold an associate or bachelor's degree in nursing.
- Hold a current, unrestricted RN license in the state for which you are applying.
- A BSN is preferred.
- Communicate positively, professionally, and effectively with others.
- Demonstrate effective written and oral communication skills.
- Be able to establish and maintain constructive relationships with diverse members, management, employees, and vendors.
- Demonstrate problem-solving, organizational, and time-management skills.
- Be able to work in a fast-paced environment.
Responsibilities
- Ensure members can access services appropriate to their health needs.
- Identify, assess, and manage members according to established criteria.
- Implement care plans by facilitating authorizations and referrals and deploying internal and external resources.
- Monitor and evaluate care management plans and modify them as needed.
- Work with primary care physicians, hospitalists, nurse practitioners, and specialists to develop care management treatment plans.
- Negotiate reimbursement rates when applicable and help resolve provider, claims, or service issues.
- Measure intervention effectiveness and case management outcomes.
- Contribute feedback to the development of utilization and care management policies and procedures.
- Counsel members and families about available care options and help them determine an appropriate and preferred course of action.
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