Registered Nurse Case Manager Jobs Near Me

As a RN Case Manager, your ability to manage client care with specific knowledge and experience in bedside care, symptom management, crisis intervention and family intervention are feature assets for this high-profile nursing position.

Moon River Senior Care in Ashburn, VA is now interviewing for a part-time Registered Nurse (RN) to join our team.

Currently licensed as a Registered Nurse (RN) in the state and in good standing with the Board in which he/she will practice.

We are looking for a Full Time Registered Nurse (RN) for a high-paying, flexible position doing skilled nursing visits to adult and geriatric medical / surgical patients in the Home Health Care setting. It is preferred that the RN have Home Health experience, however we will consider Registered Nurses who have at least 1 year of experience with adult or geriatric medical/surgical patients. The field registered nurse position in home health care is sometimes called a case manager, as you will be managing the cases of your home health patients. Some of the Benefits for the Full Time Home Health RN position: Traveling is part of your salary, but I want to make sure that you are fine with traveling as that is an integral part of home health? 4. Home Health is paid for by Medicare, and Medicare requires nurses to fill out a document called OASIS when starting any patient on services.

Born in the wake of "the great resignation", Alleghany-Greenbrier Human Capital, a subsidiary of HarrisFields Seach Partners, N.A., is a multi-discipline-focused direct-hire search firm, headquartered in the heart of the nation's capital.Job DescriptionAllegheny-Greenbrier’s client, a Medicare-certified in-home skilled nursing, personal care, and rehabilitation provider servicing the Mid-Atlantic region of the United States, is actively recruiting a full-time/permanent registered nurse (RN) case manager in Fairfax, Virginia. QualificationsWell-qualified applicants must: A registered nurse (RN) in good professional standing Be cardiopulmonary resuscitation (CPR)/first aid certified Have prior Individual and Family Developmental Disabilities Support (IFDDS) waiver experience Have prior Commonwealth Coordinated Care Plus (CCC+) experience Have prior in-home- or hospice-care experience Additional InformationAll your information will be kept confidential according to EEO guidelines.

$2,500 SIGN ON BONUS FOR EXTERNAL APPLICANTS

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration, and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Registered Nurses will be working with patients primarily in a long-term care facility setting. An RN functions as part of the primary care team, and reports to the Clinical Services Manager (CSM). The RN performs activities that fall within the RN scope of practice. This role works in close collaboration with all the team members and may support multiple providers. The RN works under the direction of the provider, and activities are delegated to the RN by the provider or the team CSM. The RN understands and supports the CPM models of care Institutional Special Needs Plan (ISNP), Institutional Special Needs Plan (IESNP) and Transitions to Skilled (TTS) and works in collaboration with the team to meet the goals of the program. RN may be required to provide on-site clinical support to patients or facilities

Location: This position is throughout Baltimore, Montgomery, Prince Georges, Anne Arundel Counties, Maryland

Work Schedule: Monday through Friday 8am-5pm. Possible early or after hours depending on business needs and weekend work could be required depending on business/member needs.

Primary Responsibilities:

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• Reports to Clinical Services Manager
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• Assess the health status of members as within the scope of licensure and with the frequency established in the model of care
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• Establish goals to meet identified health care needs
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• Plan, implement and evaluate responses to the plan of care
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• Work collaboratively the multidisciplinary team to engage resources and strategies to address medical, functional, and social barriers to care
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• Works closely with mental health clinicians to help bridge the gap between mental and physical health
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• Consult with the patient's PCP, specialists, or other health care professionals as appropriate
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• Assess patient needs for community resources and make appropriate referrals for service
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• Facilitate the patient's transition within and between health care settings in collaboration with the primary care physician and other treating physicians
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• Completely and accurately document in patient's electronic medical record
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• Provide patients and family members with counseling and education regarding health maintenance, disease prevention, condition trajectory and need for follow up as appropriate during each patient visit
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• Verify and document patient and/or family understanding of condition, plan of care and follow up recommendations
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• Actively participate in organizational quality initiatives
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• Participate in collaborative multidisciplinary team meetings to optimize clinical integration, efficiency, and effectiveness of care delivery
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• Maintain credentials essential for practice, to include licensure, certification (if applicable) and CEUs
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• Demonstrate a commitment to the mission, core values and goals of UnitedHealthcare and its healthcare delivery including the ability to integrate values of compassion, integrity, performance, innovation and relationships in the care provided to our members
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What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

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• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
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• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
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• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
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• 401(k) Savings Plan, Employee Stock Purchase Plan
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• Education Reimbursement
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• Employee Discounts
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• Employee Assistance Program
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• Employee Referral Bonus Program
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• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
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• More information can be downloaded at: http://uhg.hr/uhgbenefits
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You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

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• Associates degree or higher in nursing
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• Reside in Maryland and have a current unrestricted RN License in the state of Maryland
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• 2+ years of experience in post-acute care, such as long-term care or hospice experience as an RN
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• 2+ years of experience in assessing the medical needs of patients with complex behavioral, social and/or functional needs as a RN
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• Ability to travel up to 100% of the time for field-based work, valid driver's license
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• 6-months of experience strong computer skills, including use of Electronic Medical Records
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• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state, and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
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Preferred Qualifications:

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• Baccalaureate degree - BSN
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• Familiarity with the long-term care business environment
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• Experience working with the geriatric population
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Soft Skills:

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• Effective time management and communication skills
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• Ability to work with diverse care teams in a variety of settings including non-clinical setting
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To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So, when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

**PLEASE NOTE** The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Montgomery County, MD, Maryland, field travel, RN, Registered Nurse, UHG, health care, #RPO, #red, #ISNP, hiring immediately

People Encouraging People participates in community behavioral health services.

Large hospice company is currently seeking an experienced Registered Nurse - Case Manager to cover the Rockville, MD - Montgomery County area - full-time! Location: Rockville, MD Montgomery County

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research.

Job Title:

Nurse Case Manager

Employment Type:

Full Time

Shift:

Day

(SUMMARY) Position Highlights:

• Competitive pay
• Additional Benefits: Relocation assistance, tuition reimbursement, free parking
• Quality of Life: Flexible work schedules
• Advancement: Opportunities to advance through the Clinical Advancement Program
• Location: Holy Cross Health has two hospitals and four healthcare centers all a short driving distance from Washington DC and Baltimore, MD

Description:

• Full-Time 8am - 4:30pm
• Reporting to the Director of Care Management
• Case Managers works with a high degree of autonomy, are responsible for establishing clinical appropriateness for inpatient admission or observation status, regardless of payer source. Discusses with and informs physicians of appropriate patient status, based upon medical record documentation. Works closely with physicians, nurses, and admission and registration staff.

Responsibilities:

• Provides patient and family education about disease management and expected outcomes
• Implements case management activities for all age groups that promote continuous improvement in the coordination of care (birth to geriatric)
• Monitors and manages clinical resource consumption, ensures clinical documentation is accurate
• Provides continuity of care and post hospital planning in order to optimize cost efficient resource utilization and reduce re-hospitalization

What you will need:

• RN licensed by the State of Maryland.
• 2-4 years of hospital experience in Critical Care, Emergency Medicine or Med-Surg
• BSN required or Associates Degree with CCM certification

About us:

Holy Cross Health is a Catholic, not-for-profit health system that serves more than 240,000 individuals each year from Maryland's two largest counties - Montgomery and Prince George's counties. Holy Cross Health earns numerous national awards, clinical designations and accreditations across a wide range of specialties for providing innovative, high-quality health care services.

We were named one of America's 100 Best Hospitals for 2022.

Holy Cross Health is an Equal Employment Opportunity (EEO) employer.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.

Registered Nurse - Case Manager - Travel Contract / Travel Contract

If so, now is the time to choose Zion Medical Healthcare as your employer.

If so, AIDS Healthcare Foundation is the place for you! Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation.

The Bilingual RN Case Manager will be responsible for in-person visits and telephonic follow up care throughout the greater Milwaukee area

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential.

The RN Case Manager will be at the forefront of this intensive, adaptive, and patient-focused model. As an RN Case Manager, you will manage the medical needs of a caseload of patients as they navigate the staged progression of chronic kidney disease (CKD).

Must have a valid license as a Registered Nurse in Florida.

preferred Unencumbered California Registered Nurse (RN) License

$5000 Sign On Bonus!

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today!

If you are located within the state of New Jersey area you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

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• Make outbound calls to assess members' current health status
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• Demonstrate an ability to deliver effective telephonic case management in a manner that promotes behavior change for the NJ
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• Identify gaps or barriers in treatment plans
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• Provide patient education to assist with self-management
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• Interact with Medical Directors on challenging cases including presenting at rounds
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• Coordinate care for members
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• Make referrals to outside sources
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• Coordinate services as needed (home health, DME, etc.)
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• Educate members on disease processes
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• Encourage members to make healthy lifestyle changes
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• Document and track findings
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• Make “welcome home” calls to ensure that discharged member receive the necessary services and resources
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You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

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• Current, unrestricted RN license in New Jersey
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• 2+ years of RN experience in a hospital setting, acute care, direct care experience and/or experience as a Case Manager
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• 1+ years of paid professional experience working directly with the elderly or physically disabled in an institutional or community setting
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• Experience in long-term care, home health, hospice, public health or assisted living
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• Ability to navigate a Windows environment, utilize Outlook, and the ability to create, edit, save and send documents utilizing Microsoft Word and Excel
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• Ability to talk and type proficiently at the same time
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• Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance
• 
  

Preferred Qualifications:

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• Bachelor's Degree or greater
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• Certified Case Manager (CCM)
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• DSNP
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• Experience working with populations with special needs
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• Experience/exposure with discharge planning
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• Experience in utilization review, concurrent review and/or risk management
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• Experience with government health programs (Medicaid / Medicare)
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• Case Management experience
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• Background in managed care
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• Bilingual - English/Spanish
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• Solid organizational skills and multitasking abilities
• 
  

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

**PLEASE NOTE** The Sign-On Bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Morgan Stephens ofrecemos reclutadores que hablan Espanol

Registered Nurse with current, unrestricted MA state license is required.

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County.

JOB SUMMARY:

• Registered Nurse will make outreach calls to members for engagement and enrolment into the Case Management program.
• Build and maintain a caseload of 73.

HIGHLIGHTS:

• Mon-Fri, 8a-5p
• 100% REMOTE/Work from Home opportunity
• Registered Nurse MUST live in Indiana to be considered
• 1-year contract to hire position
• 4-6 weeks of training provided virtually
• Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
• 401k after 1 year of employment: With employer match and profit sharing
• The salary for this position is $85,280K

QUALIFICATIONS:

• Active RN License in the State of IN
• MUST HAVE experience in Peds, NICU or Special Nursery
• Case Management experience preferred
• Computer savvy

PLEASE CALL OR TEXT: Alliston Brown @ 586-710-7944

Registered nurse, RN, nurse, nursing, case management, case manager, CCM, certified case manager, NICU, neonatal intensive care, PEDS, pediatric intensive care, PICU, special nursery, hospital, acute care, clinic, critical care, clinical, telephone, work from home, remote, managed care, insurance, health plan, health insurance, Medicaid, Medicare, discharge planning, disease management, chronic condition

Provides nursing, clinical, casework services by performing the following duties: Essential Duties and Job Responsibilities: Effectively manages a caseload of 22-25 active field case management files if full field, 45-55 telephonic case management files, or 35-45 if mixed TCM/FCM depending on complexity. Part time employees handle case load of 12-18 files dependent on acuity and determine by supervisor and medical manager.All full time medical case managers are required to bill a minimum of 40 hours per week. Part time to be discussed and decided upon by supervisor.Maintains the Outlook calendar by keeping all meetings and/or appointments current and documenting changes as they occur, throughout the week, that will be available for weekly review Tasks must be kept current and be updated on a daily basis Attends and participates in all mandatory meetings, training or corporate events, within person or through electronic means, as required Initial four-point contacts must be made within 24-48 hours from the date of the referral and the initial email must be sent immediately thereafter Timely closure of files with internal charting complete and up to date, including impact points Understands and demonstrates the ability to apply Eagle One™ case management protocols Consults with Manager and internally roundtables on complex cases, claim barriers and on resolution planning.Demonstrates the ability to effectively create medical timelines Prepares case summaries for account claim reviews Responsible for maintaining a complete medical file which is kept in chronological order with no duplication of information in a paperless format Alerts Manager of any requests to deviate from Eagle One™ or account specific protocols and obtains approval to proceed as necessary Utilizes appropriate cost management programs per account or company protocol (i.e., Pharmacy, DME, etc.) Responsible for initial and ongoing analysis of the diagnosis as it relates to the work injury and the medical treatment rendered Provides expert consultation for interpretation of medical information and how it impacts the case Projects anticipated dates for modified and full-duty work releases utilizing disability/medical criteria and documenting any deviations at each appointment Continually addresses physical job demands and job availability at physician appointments to encourage appropriate work release Contacts medical providers within 24 hours of appointments to obtain disability and medical status Determines and documents appropriateness of medical treatment and whether or not the treatment meets disability/medical criteria throughout claim duration Updates employer and any other appropriate parties with any change in disability or medical status and appointment information within 24 hours of appointment date and coordinates return to work per protocol Adheres to jurisdictional rules and regulations and applies to each case as appropriate Attends all field visits as requested by client and account protocols and/or is available for field visits as needed, per Account Instructions and at client request, within an average 2 hour radius from home office.Meets or exceeds Eagle One™ guidelines for return-to-work outcomes and medical closure durations Involved in Public Health community wellness fairs and clinics as needed If PRN case manager, perform tasks as requested and attend appointments as needed per field guidelines. Qualifications To perform this job successfully, an individual must be detail-oriented with exceptional communication and interpersonal skills. Nurse must also have exceptional writing skills for reports as well as comfortability navigating a computer. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience:· Active RN licensure in state of employment· Bachelor’s Degree preferred· Additional certifications a plus (i.e. CCM, CDMS, CLNC) Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions. Computer Skills: To perform this job successfully, an individual should have knowledge of Microsoft Windows/Office (Word, Excel and Outlook), be able to navigate the internet for the purpose of research and have a general/overall working knowledge of computer navigation. Typing skills of 45+ wpm Professional Skills:· Knowledge of workers’ compensation jurisdictional rules/regulations a plus· Ability to work in a fast-paced environment· Strong organizational skills a must· Excellent written and verbal communication skills· Excellent customer service skills required· Previous case management experience a plus· Clinical experience in an orthopedic or occupational health setting a plus· Bilingual a plus· Valid driver’s license and ability to drive to/from appointments if hired as a field case manager Competency:To perform the job successfully, an individual should demonstrate the following competencies: Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. Team Work - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Recognizes accomplishments of other team members. Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values. Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity. Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events. Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time. Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan. Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed. Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions. Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals. Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans. Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. Supervisory Responsibilities: This job has no supervisory responsibilities. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must frequently lift and/or move up to 10 pounds.While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear. The employee is frequently required to stand; walk; sit and reach with hands and arms. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus. Company DescriptionWe’re Hiring!

*Eagle One Case Management Solutions
We are looking for a Field Case Manager in the Milwaukee, WI. area
This is a Monday- Friday position 8:00 am to 5:00 pm, weekends and Holidays off.
Why Choose EagleOne
• Competitive salary
• Comprehensive and competitive benefits package including vacation days (PTO), health, dental, vision, 401K, STD, LTD and life insurance
• Growth and advancement opportunities
• Supportive team environment

We can’t wait to hear from you! Send your resume and cover letter to:
dstark@eagleonecms.com

• PAY: $45.00 to 47.00 (per hour)
• BENEFITS: Medical - Dental - Vision (eligible day 1)
• HOURS: M-F | 8am to 5pm (ET)
• LOCATION: Remote (must reside in the state of Indiana)

REQUIRED SKILLS:

• 3+ years RN experience / Active RN License
• Case Management, Care Management (preferred)
• Pediatrics or Special Care Nursery or NICU (preferred)
• Motivated, Self-starter capable to work autonomously and in groups.

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.

RESPONSIBILITIES:

• 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

• Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan

• Identify related risk management quality concerns and report these scenarios to the appropriate resources.

• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems

• Other duties / responsibilities assigned

#INDAS

High Intensity RN Case Manager - Managed Care

Questpro is currently partnered with a leading National Managed Care Provider looking for a Field Nurse Case Manager to work from home and cover the Des Moines, IA area. Location: Based in either: Greater Des Moines or Iowa City

Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or providing health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor, and evaluate the medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost-effective outcomes.
+ 50% Performs medical or behavioral review/authorization process. + Ensures coverage for appropriate services within benefit and medical necessity guidelines. + Assesses service needs, develops and coordinates action plans in cooperation with members, monitors services, and implements plans. + Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. + May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. + Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. + 20% Utilizes allocated resources to back up review determinations. + Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). + Participates in data collection/input into the system for clinical information flow and proper claims adjudication. + Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but are not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). + 10% Participates indirect intervention/patient education with members and providers regarding health care delivery system, utilization of networks and benefit plans. + Serves as member advocate through continued communication and education. + Promotes enrollment in care management programs and/or health and disease management programs. + Provides telephonic support for members with chronic conditions, high-risk pregnancy, or other at-risk conditions that consist of intensive assessment/evaluation of the condition, at-risk education based on members' identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. + 10% Maintains current knowledge of contracts and network status of all service providers and applies appropriately. + Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. + 10% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. Required Skills and Abilities: + Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. + Good judgment skills. + Demonstrated customer service, organizational, and presentation skills. + Demonstrated proficiency in spelling, punctuation, and grammar skills. + Demonstrated oral and written communication skills. + Ability to persuade, negotiate, or influence others. + Analytical or critical thinking skills. + Ability to handle confidential or sensitive information with discretion. Software and Tools: + Microsoft Office. + Working knowledge of spreadsheet, database software. + Knowledge of contract language and application. + Thorough knowledge/understanding of claims/coding analysis/requirements/processes. + Working knowledge of Microsoft Excel, Access or other spreadsheet/database software. Required Education: Associate Degree - Nursing or Graduate of Accredited School of Nursing. Preferred Education: Bachelor's degree- Nursing. Preferred Work Experience: 7 years-healthcare program management, utilization review, or clinical experience in the defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery Required License and Certificate: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) in the state of hire. About Actalent: Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We're supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

We are hiring full time RN s interested in discovering or continuing their career in case management. Valid driver s license and ability to drive to/from appointments if hired as a field case manager