RN Case Manager - Telephonic, Managed Care

PriMed Management Consulting Services; United States; On-site; USD 100,000 - 123,000; Full time

Job summary

Hill Physicians Medical Group seeks a clinical nurse case manager to coordinate care for PPO members. This role conducts assessments, develops care plans, and collaborates with health plans and providers to improve outcomes while controlling costs. All contacts are telephonic.

Requirements include a California RN license, an A.S. degree, at least three years of nursing experience and two years in case management or related areas; knowledge of ICD-9/CPT coding and Epic is preferred.

Qualifications

• Three years of clinical nursing experience in medical/surgical, critical care, home health, or skilled nursing.
• Two years in case management, behavioral health, utilization management, discharge planning, or quality improvement in managed care.
• Experience with managed care delivery including IPA networks and Medicare; PPO experience preferred.
• Strong organizational skills with ability to meet deadlines.
• Excellent verbal and written communication skills.
• Ability to coordinate with members, providers, staff, health plans, and community resources.
• Knowledge of ICD-9 and CPT coding.
• Working knowledge of personal computers.

Responsibilities

• Collaborate with Health Plans care and disease management programs to maximize at‑risk members' quality and manage their costs.
• Assess members' physical and psychosocial needs and develop a care plan.
• Support and encourage the use of participating Health Plan providers.
• Develop and implement interventions 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 related activity.

Skills

Communication skills

Independent work

Organizational skills

ICD-9/CPT coding knowledge

Education

A.S. degree

California RN licensure

Case management certification (preferred)

Job description

Hill Physicians Medical Group seeks a clinical nurse case manager to coordinate care for PPO members. This role conducts assessments, develops care plans, and collaborates with health plans and providers to improve outcomes while controlling costs. All contacts are telephonic.

Requirements include a California RN license, an A.S. degree, at least three years of nursing experience and two years in case management or related areas; knowledge of ICD-9/CPT coding and Epic is preferred.