PPO Case Manager - Telephonic Care Coordination

PriMed Management Consulting Services, Inc.; United States; Remote; USD 100,000 - 123,000; Full time

Job summary

Hill Physicians Medical Group is seeking a Case Manager Registered Nurse to carry out telephonic case management for PPO members identified through data or Health Plan referrals. Responsibilities include assessing needs, developing care plans, coordinating with providers, and documenting in Epic.

Requirements include 3+ years nursing experience, 2+ years in case management in managed care, and California RN licensure. Salary range offered: $100,100–$123,000 annually.

Qualifications

• Three years minimum clinical nursing experience in medical/surgical, critical care, home health or skilled nursing.
• Two years of experience in case management, behavioral health, utilization management, discharge planning, and/or quality improvement in a managed care setting.
• Experience with managed care delivery including IPA networks and Medicare. PPO experience preferred.
• Strong organizational, time management, and communication skills.

Responsibilities

• Collaborate with Health Plans care and disease management programs to maximize the at-risk population member’s quality and manage their costs.
• Assess members’ physical and psychosocial needs and develop a care plan.
• Coordinate care and document in Epic; assessments, care plans, interventions, and all activity related to coordinating the care of case-managed members.
• Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.

Skills

Case management

Nursing

Communication skills

ICD-9/CPT knowledge

Independent work

Education

A.S. degree

RN licensure (unrestricted)

Tools

Epic

Job description

Hill Physicians Medical Group is seeking a Case Manager Registered Nurse to carry out telephonic case management for PPO members identified through data or Health Plan referrals. Responsibilities include assessing needs, developing care plans, coordinating with providers, and documenting in Epic.

Requirements include 3+ years nursing experience, 2+ years in case management in managed care, and California RN licensure. Salary range offered: $100,100–$123,000 annually.