RN II – Primary Nurse Care

Jobtailor; Deutschland; Remote; EUR 55.000 - 75.000; Vollzeit

Zusammenfassung

Jobtailor is seeking an RN Care Coordinator to perform clinical assessments and develop individualized care plans for members. You will coordinate with providers, payers, and families to ensure appropriate, high-quality care across the continuum, including transitional care.

The role emphasizes utilization management, documentation standards, and participation in quality improvement while mentoring staff and engaging in audits as needed.

Qualifikationen

• Requires a minimum of two (2) years clinical experience.
• Requires a minimum of three (3) years' experience in the health care delivery system/industry.
• Active Unrestricted RN License; NJ License and/or Compact License.
• Proficiency in Windows-based software and MS Office.
• Health care payer experience strongly preferred.
• Bi-lingual proficiency preferred.

Aufgaben

• Perform RN duties for the Primary Nurse population using guidelines to ensure appropriate level of care.
• Plan transitions to the continuum of care and develop member-centric plans of care.
• Outreach to high-risk members and engage in preventative care opportunities.
• Assess members’ clinical needs against guidelines and benefit structures.
• Coordinate with members, families, physicians, hospitals regarding appropriateness of care.

Kenntnisse

Care Coordination

Clinical Assessment

Individualized Care Plans

Utilization Management

Disease Management

Health Care Contracts Knowledge

Windows Based Software Proficiency

MS Office Proficiency

Documentation Standards

Quality Improvement

Ausbildung

High School Diploma/GED

Bachelor degree preferred

Relevant experience in lieu of degree

Tools

MS Word

MS Excel

MS PowerPoint

Microsoft Outlook

Jobbeschreibung

• Perform RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care.
• Plan transitions to the continuum of care and develop member-centric plans of care.
• Outreach to high-risk members and engage members in preventative care opportunities and screenings.
• Assess members’ clinical needs against established guidelines and benefit structures.
• Facilitate responses to gaps in care and direct high-risk members to appropriate care settings.
• Evaluate the necessity, appropriateness, and efficiency of medical services and procedures for acute and chronic needs.
• Develop, coordinate, and assist in implementing individualized plans of care and identify barriers to self-management and optimal wellness.
• Coordinate with members, families, physicians, hospitals, and external customers regarding appropriateness of care.
• Coordinate high-quality, cost-effective care across the continuum, including transitional care.
• Monitor members’ medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for members and families across care sites to coordinate resource utilization and evaluate services.
• Encourage member participation and compliance in case/disease management programs.
• Document accurately and comprehensively according to standards and organizational policies.
• Communicate with multidisciplinary teams telephonically and/or in person.
• Evaluate care, analyze variances, and participate in quality improvement programs.
• Mentor and train new RNs and other staff as needed.
• Present clinical cases during audits conducted by external review organizations.
• Perform other duties as assigned by management.
• Positions involving ASO accounts may require some travel for on-site availability.

Requirements

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Requires a minimum of two (2) years clinical experience.
• Requires a minimum of three (3) years' experience in the health care delivery system/industry.
• Experience with both acute and chronic conditions preferred.
• Experience with health care payer experience strongly preferred.
• Active Unrestricted RN License Required; NJ License required and/or Compact License.
• Requires a valid Driver's License and Insurance.
• Proficiency in personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, and PowerPoint) and Microsoft Outlook.
• Working knowledge of case/care/disease management principles.
• Working knowledge of utilization, case and/or disease management processes.
• Working knowledge of utilization management principles.
• Basic knowledge of health care contracts and benefit eligibility requirements.
• Knowledge of hospital structures and payment systems.
• Bi-lingual proficiency preferred.
• Skills in adaptability/flexibility, analysis, compassion, information/knowledge sharing, interpersonal and client relationship management, sound decision making, active listening, organization planning/priority setting, problem solving/critical thinking, teamwork, time management, and written/oral communications.

Core Competencies

Demonstrates expertise in care coordination, member advocacy, and clinical assessment, with a strong focus on developing and implementing individualized care plans. Proficient in utilizing case management principles and collaborating with multidisciplinary teams to ensure high-quality, cost-effective care.

Highest-signal resume keywords

• Active Unrestricted RN License
• Clinical Experience
• Health Care Payer Experience
• Utilization Management Principles
• Case Management Principles

ATS Optimization Keywords

Hard Skills

• Clinical Assessment
• Care Coordination
• Individualized Care Plans
• Utilization Management
• Disease Management
• Health Care Contracts Knowledge
• Windows Based Software Proficiency
• MS Office Proficiency
• Documentation Standards
• Quality Improvement Participation

Soft Skills

• Interpersonal Skills
• Problem Solving
• Time Management
• Teamwork
• Active Listening

Certifications & Qualifications

• RN License
• NJ License
• Compact License
• Valid Driver's License

Industry Keywords

• Health Care Delivery System
• Acute Conditions
• Chronic Conditions
• Member-Centric Care
• Transitional Care

Tools & Technologies

• MS Word
• MS Excel
• MS PowerPoint
• Microsoft Outlook