Remote Case Manager, RN – Managed Care & Care Coordination

PriMed Management Consulting Services, Inc.; San Ramon (CA); On-site; USD 100,000 - 123,000; Full time

Job summary

Hill Physicians Medical Group in California is seeking an experienced registered nurse to perform case management for PPO members identified through data or Health Plan referrals. This role requires collaboration with health plans, patient assessment, care planning, and documenting all activities in Epic.

Minimum three years of clinical nursing plus two years in case management within a managed care setting are required.

Qualifications

• Minimum three years 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.
• Excellent verbal and written communication skills.
• Ability to coordinate effectively with members, providers, office staff, health plans, internal department, community resources, and peers.
• Knowledge of ICD-9 and CPT coding; working knowledge of personal computers.

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/barriers and develop a care plan.
• Support and encourage the use of participating Health Plan providers.
• Develop and implement the interventions needed to resolve barriers and coordinate care, allowing members to accomplish their goals with physician guidance and supervision.
• Document in Epic; assessments, care plans, interventions, and all other 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.
• Maintain department procedure/policy standards with regard to turnaround time, etc.
• Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.
• Coordinate internal and external resources for the individual member.
• Maintain and update a community resource database.
• Document all case management activities in the HPMG case management online system.

Skills

Verbal communication

Written communication

Organizational skills

Independent work

Education

AS degree

Tools

Epic

Job description

Hill Physicians Medical Group in California is seeking an experienced registered nurse to perform case management for PPO members identified through data or Health Plan referrals. This role requires collaboration with health plans, patient assessment, care planning, and documenting all activities in Epic.

Minimum three years of clinical nursing plus two years in case management within a managed care setting are required.