RN - Care Management Coordinator Job

RN - CARE MANAGEMENT COORDINATOR needed for a CONTRACT opportunity with Yoh's client located in Fort Washington, PA.

TOP SKILLS YOU SHOULD POSSESS:

- Registered nurse
- Utilization management - InterQual

WHAT YOU'LL BE DOING:

- This position is responsible for overseeing and coordinating medical care provided to members, ensuring that appropriate and cost-effective care is rendered.
- Maintain quality care standards, and limits the member's and client's exposure to medically unnecessary and inappropriate treatment.
- Evaluate proposed plans of treatment, as defined in the precertification requirements of the group plan using the medical criteria of InterQual and/or Medical Policy.
- Directs the delivery of care to the most appropriate setting, while maintaining quality.
- Contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for inpatient stay or continued inpatient care
- Identifies admissions no longer meeting criteria and refers care to plan Medical Directors for evaluation.
- Performs early identification of members to evaluate discharge planning needs.
- Identifies and refers cases for case management and disease management.
- Identifies quality of care issues including delays in care
- Appropriately refers cases to the Quality Management Department and/or Sr. Clinical Svcs Nurse when indicated.
- Reports potential utilization issues or trends to designated manager or senior clinical nurse and recommendations for improvement
- Participates in the process of educating providers on managed care

WHAT YOU NEED TO BRING TO THE TABLE:

- Active NJ or PA Licensed Registered Nurse required
- Minimum Five years clinical experience or equivalent required
- Intensive Care, Trauma, Home Health a plus
- Medical management/precertification experience preferred

OPPORTUNITY IS CALLING, APPLY NOW!

RECRUITER: Karly Settle

EMAIL: (see below)

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Contact us if you are an individual with a disability and require accommodation in the application process.

J2W: HC

MONJOB

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SFSF: HC

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