Nurse Case Manager
About The Position
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. We are seeking a Nurse Case Manager to provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs, and improve healthcare program/operational efficiency involving clinical issues. The Nurse Case Manager will identify and follow through with continuous quality/compliance opportunities and educate/empower members to ensure compliance, satisfaction, and promote patient advocacy. This role involves assessing member needs and benefit plan eligibility, applying clinical judgment to reduce risk factors, and addressing complex health and social indicators. Assessments will consider multiple diagnoses, work capacity, and related limitations, with a holistic approach to referrals for functionality assessments. The Nurse Case Manager will consult with supervisors, present cases at conferences, and utilize case management processes in compliance with regulatory and company policies. The position requires strong interviewing skills to ensure maximum member engagement and discern health status and needs.
Requirements
- Active RN license in Virginia required
- Associate or Bachelor's in nursing
- RN
- Case management
- Discharge planning experience preferred
Responsibilities
- Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment.
- Effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.
- Facilitate optimal outcomes.
- Identify and follow through with continuous quality/compliance opportunities.
- Educate and empower members to ensure compliance, satisfaction, and promote patient advocacy.
- Conduct an evaluation of member's needs and benefit plan eligibility using clinical tools and data review.
- Facilitate integrative functions and smooth transition to programs and plans.
- Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers.
- Address complex health and social indicators which impact care planning and resolution of member issues.
- Assess member's level of work capacity and related restrictions/limitations.
- Assess the need for a referral to clinical resources for assistance in determining functionality.
- Consult with supervisor and others in overcoming barriers in meeting goals and objectives.
- Present cases at case conferences for multidisciplinary focus to benefit overall claim management.
- Utilize case management processes in compliance with regulatory and company policies and procedures.
- Utilize interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
- Telephonically and/or face to face assess, plan, implement, and coordinate all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
- Develop 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
