RN Care Manager – Case Management & Quality

Jobtailor; Virginia (MN); On-site; USD 85,000 - 100,000; Full time

Job summary

Jobtailor is seeking a registered nurse for a case management role in the United States. The position focuses on identifying high-risk members, coordinating care with in-network providers, and supporting utilization reviews to uphold accreditation standards.

Required are an active RN license, three years of healthcare clinical experience, and two years of care management experience, with BSN or ASN qualifications preferred and BSN completion within three years of hire.

Qualifications

• Current RN license issued by the state where services are provided, or multi-state license via eNLC.
• Three years of healthcare clinical experience.
• Two years of care management experience.
• Management of Medicare and/or Medicaid populations.

Responsibilities

• Identify and connect high risk members to appropriate resources and programs to achieve optimal quality and financial outcomes.
• Manage and triage self-referrals and identify high risk members through HRA, reporting and admissions data.
• Audit patient charts of delegated case management programs to meet accreditation standards.
• Connect members with in-network providers and resources.
• Assist in utilization management reviews and ensure quality standards in auditing processes.
• Participate in case management and quality committees.

Education

Bachelor's Degree in Nursing

Associate of Science in Nursing (ASN)

BSN program enrollment / BSN completion within 3 years

Job description

Jobtailor is seeking a registered nurse for a case management role in the United States. The position focuses on identifying high-risk members, coordinating care with in-network providers, and supporting utilization reviews to uphold accreditation standards.

Required are an active RN license, three years of healthcare clinical experience, and two years of care management experience, with BSN or ASN qualifications preferred and BSN completion within three years of hire.