Care Manager RN - UM (Full-Time) Weekends (Remote)
About The Position
This full-time remote position implements utilization management strategies, including reviewing the appropriateness of health care services, applying criteria to support appropriate resource utilization, identifying opportunities for referral to Health Coach or case management, and identifying and resolving quality issues. The role monitors and analyzes health care service delivery, proactively educates providers and members, analyzes qualitative and quantitative data to improve provider and member satisfaction, and responds to customer inquiries with interventions or alternatives. The position requires availability on Saturdays and Sundays in addition to three weekdays. The Care Manager implements reviews according to established industry, corporate, regulatory, ethical, and professional standards. The role promotes quality and efficiency, protects member privacy, identifies members who may benefit from Health Coaching or case management, and collaborates to maximize member health outcomes. It also educates providers and vendors, develops positive relationships with internal and external customers, and uses outcomes data to improve care management services.
Requirements
- At least 3 years of related, progressive clinical experience in the area of specialization.
- Experience in a clinical setting.
- Current Pennsylvania RN licensure or current multistate licensure through the enhanced Nurse Licensure Compact (eNLC); additional state licenses may be required depending on where clinical care is provided.
- Working knowledge of relevant regulatory and compliance guidelines and medical policies.
- Ability to multitask and perform in a fast-paced, often intense environment.
- Excellent written and verbal communication skills.
- Ability to analyze data, measure outcomes, and develop action plans.
- Enthusiasm, innovation, and flexibility.
- Team orientation with strong analytical and organizational skills.
- Ability to prioritize work demands and meet deadlines.
- Excellent computer and software knowledge and skills.
- Availability to work Saturdays and Sundays, in addition to three weekdays.
Nice To Haves
- Bachelor’s degree in Nursing.
- Three years of RN experience.
- RN Case Management or Care Management experience.
- Experience in utilization management, case management, quality assurance, or managed care.
- Experience with acute inpatient and post-acute care.
- Experience with skilled nursing or inpatient rehabilitation.
- Certification in Utilization Management or a related field.
Responsibilities
- Implement care management review processes consistent with industry and corporate standards and within the care manager’s professional discipline.
- Comply with applicable state and federal laws and regulatory requirements.
- Conduct care management reviews using accepted criteria, approved guidelines, and medical policies.
- Promote quality and efficiency in care management services.
- Protect member privacy and share only information relevant to the member’s care and permitted by applicable laws.
- Practice according to ethical principles.
- Identify and refer members who may benefit from Health Coaching or case management interventions.
- Use collaborative interventions to facilitate and maximize members’ health care outcomes, drawing on knowledge of care options and provider resources.
- Educate professional and facility providers and vendors to streamline and improve processes and build network relationships.
- Develop and sustain positive working relationships with internal and external customers.
- Use outcomes data to improve ongoing care management services.
- Perform other duties as assigned or requested.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
