Top 7252 Rn Case Manager Jobs

RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
Patient Care Manager
Optum —Shelbyville, KY
- $85,196 - $127,794 a year
- Full-time
- CPR Certification
- Management
- RN License
- Health insurance
RN - Case Manager - AS Utilization Management - Part Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
TX, RN Certified Case Manager - Workers Compensation
The Reny Company —Dallas, TX
- $80,000 - $90,000 a year
- 8 hour shift
- Remote
- Nursing
- RN License
- Research
- Mileage reimbursement
- Disability insurance
Quick Apply
Case Manager / RN
MedWatch —Remote
- $72,000 - $81,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Residential
Clinical Case Manager, RN / Nurse Ambassador
United Biosource Corporation —Remote
- Overtime
- Remote
- Nursing
- RN License
- Research
- Wellness program
- Health savings account
Clinical Case Manager-RN
For The People of Georgia, LLC —Atlanta, GA
- $100 - $500 a day
- Contract
- Remote
- Nursing
- Mid-level
- Bachelor's degree
- Flexible schedule
Quick Apply
Ambulatory Case Manager, RN
TEXASCONNECT INC —Remote
- Full-time
- Remote
- RN License
- Computer literacy
- Mid-level
Case Manager Registered Nurse (Remote, Illinois)
CVS Health —Illinois
- $66,575 - $142,576 a year
- Full-time
- Remote
- Bilingual
- Nursing
- Microsoft Outlook
- Health insurance
- Dental insurance
5d
Case Manager (RN) - Inpatient - 0.8 FTE, 08-hr, Day Shift
Stanford Health Care —Palo Alto, CA
- $96.35 - $111.14 an hour
- Part-time
- Nursing
- RN License
- Hospital
14d
RN Case Manager- Chronic Care Management
Belle, LLC —Dallas, TX
- $70,000 - $80,000 a year
- Full-time
- Remote
- Spanish
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Case Manager
Stanford Health Care Tri-Valley —Pleasanton, CA
- $70.57 - $95.29 an hour
- Full-time
- Acute care
- Nursing
- RN License
Workers Compensation Nurse Case Manager - Filed or TCM
IW Care Connection, Inc. —Remote
- $93,600 - $130,000 a year
- Part-time
- Remote
- Spanish
- Microsoft Excel
- RN License
- Health insurance
- Dental insurance
Quick Apply
3d
RN Case Manager, 4W, 40 Hours (Days / 4x10 Hour Shifts / Every 6th Weekend)
Boston Medical Center —Boston, MA
- $38.05 - $75.33 an hour
- Full-time
- Nursing
- RN License
- Writing skills
- Health insurance
- Dental insurance
Case Manager
Montefiore St. Luke's Cornwall —Newburgh, NY
- $46.84 - $65.21 an hour
- Full-time
- Nursing
- RN License
- Hospital
Case Manager, Registered Nurse
CVS Health —Florida
- $60,522 - $129,615 a year
- Full-time
- Remote
- Spanish
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance
5d
RN Case Manager
Insight —Chicago, IL
- $51 - $60 an hour
- Part-time
- RN License
- Hospital
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Case Manager RN
AHMC Healthcare —Riverside, CA
- $47.01 - $61.03 an hour
- Full-time
- RN License
- BLS Certification
- Mid-level
Case Manager
City of Hope —Duarte, CA
- $67.60 - $98.03 an hour
- 8 hour shift
- Nursing
- RN License
- Hospital

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RN Case Manager

MedStar Health -
Washington, DC

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Job Details

Full-time
$89,065 - $162,801 a year

Qualifications

RN License
Managing patients as a nurse case manager
Utilization management
Decision making
Patient care
Resource utilization in healthcare
Negotiation

Full Job Description

About this Job:

General Summary of Position

Coordinates negotiates procures and manages care of our members/enrollees to facilitate cost effective care and members/enrollees satisfaction. Facilitates the continuum of care works collaboratively with interdisciplinary staff internal and external to the organization. Responsible for carrying a complex case management case load ownership of a case management program(s) pre- authorization reviews to provide Medically Necessary timely and quality health care services in the most cost-effective manner and pharmacy reviews per population served. This role would include the ability to meet memebers in their homes or various community settings. We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels.

Primary Duties and Responsibilities

Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Actively develops and manages complex case management cases and develops individualized plans of care according to NCQA standards/ guidelines and the District of Columbia Contract.
Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
Acts as an advocate while assisting members/enrollees to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
Assists hospital case management staff with discharge planning if applicable. Makes recommendation to alternate tier of Case Management programs or level of care as acuity necessitate.
Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups District/ community agencies meetings etc. as assigned. Provides input completes assignments and shares new findings with other staff. Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Provides face to face case management in the community as the member/enrollee's health necessitate.
Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
Demonstrates skill and flexibility in providing coverage for other staff.
For assigned Case Management program(s) develops strategies assessment(s) and evaluation/goal tools according to NCQA standards/ guidelines and District of Columbia Contract for the population served. Utilizes standards/ guidelines to manage and document interactions for the program (s). Responsible for verifying that assigned program utilizes up-to-date standards in the medical and behavioral health community for the population served. Keeps informed about disease processes treatment modalities and resources.
Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.
Identifies inpatients requiring additional services and initiates care with appropriate practitioners.
Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
Maintains timely and accurate documentation in the clinical software system per Clinical Operation department's policy.
Monitors utilization of all services for fraud waste and abuse.
Performs telephonic ACD line coverage for Clinical Operations' needs.
Enters authorization as appropriate to the program and sends the reviews to Medical Director as appropriate. Coordinates review decisions and notifications per policy NCQA standards/ guidelines and District of Columbia Contract for timely decision making.
Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
Participates in multi-disciplinary quality and service improvement teams.

Minimal Qualifications
Education

Graduate of an accredited School of Nursing required and
Bachelor's degree preferred

Experience

1-2 years Case management experience required and
1-2 years UM or related experience required and
3-4 years Diverse clinical experience required

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia and/or the State of Maryland based on work location(s) Upon Hire required and
CCM - Certified Case Manager Upon Hire preferred

Knowledge Skills and Abilities

Verbal and written communication skills. Ability to use computer to enter and retrieve data. Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.

This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

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