RN Telephonic CM II with Managed Care Experience

Healthcare Support Staffing; Jacksonville (FL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Fun and positive work environment

Room for growth

Medical benefits 1st of the month after hire

401k Matching

Job summary

A leading healthcare staffing agency is seeking a RN Telephonic Case Manager. The role involves performing care management duties across the continuum of care for members, requiring at least 1 year of case management and 2 years of acute care nursing experience. The ideal candidate will have knowledge of healthcare managed care principles and decision support tools. This position offers a positive work environment, room for growth, and competitive medical benefits.

Qualifications

• Must be an RN with at least 1 year of case management experience in managed care.
• Requires a minimum of 2 years of acute care nursing experience.
• Knowledge of utilization management principles and healthcare managed care is essential.
• Knowledge of utilization management principles.
• Experience with medical decision support tools (InterQual, Milliman).

Responsibilities

• Perform care management duties for medical and supporting services.
• Assess member's health status and treatment options.
• Develop plan of care with specific objectives.
• Coordinate services across healthcare providers.
• Provide patient and provider education.
• Monitor referrals and document assessments in management systems.
• Participate in team rounds and case management committees.

Skills

Case management

Utilization management

Patient education

Coordination of care

Critical thinking

Education

Registered Nurse (RN) license

Tools

InterQual

Milliman

Job description

RN Telephonic CM II with Managed Care Experience

Full-time

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non‑clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long‑lasting and rewarding career!

Daily Responsibilities RN Case Managers:

• Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
• Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
• Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non‑medical staff as necessary to meet the complete medical socio‑economic needs of clients
• Provide patient and provider education
• Facilitate member access to community based services
• Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources.
• Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
• Direct care to participating network providers
• Perform duties independently, demonstrating advanced understanding of complex care management principles.
• Participate in case management committees and work on special projects related to case management as needed

Requirements:

• Must be an RN
• 1+ years of case management experience in a managed care setting is required
• 2+ years of acute care nursing experience.
• Knowledge of utilization management principles and healthcare managed care.
• Experience with medical decision support tools (i.e. InterQual, Milliman)

Hours for this Position:

M-F 8-5

Advantages of this Opportunity:

• Fun and positive work environment
• Room for growth
• Medical benefits 1st of the month after hire
• 401k Matching

Interested in being considered?

If you are interested in being considered for the position, please contact Ashley Greene at 407‑478‑0332 ext 169.