Care Manager RN - Little Rock, AR
Branch ID: 2278
This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to assure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives.
- Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager's professional discipline. Effectively function in accordance with applicable state, federal laws and regulatory compliance.
- Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies. Promote quality and efficiency in the delivery of care management services.
- Respect the member's right to privacy, sharing only information relevant to the member's care and within the framework of applicable laws. Practice within the scope of ethical principles.
- Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions. Employ collaborative interventions which focus, facilitate, and maximize the member's health care outcomes. Is familiar with the various care options and provider resources available to the member.
- Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships. Develop and sustain positive working relationships with internal and external customers.
- Utilize outcomes data to improve ongoing care management services.
- Other duties as assigned or requested.
EDUCATION Preferred: Bachelor's degree in Nursing. EXPERIENCE Required: 5 to 10 years of related, progressive experience in the area of specialization. Experience in a clinical setting. Experience Preferred: Experience in UM CM QA and Managed Care. LICENSES AND CERTIFICATIONS Required: Registered Nurse (RN) license. Preferred: Certification in Utilization Management or a related field. SKILLS: Working knowledge of pertinent regulatory and compliance guidelines and medical policies. Ability to multi task and perform in a fast paced and often intense environment. Excellent written and verbal communication skills. Ability to analyze data, measure outcomes, and develop action plans. Be enthusiastic, innovative, and flexible. Be a team player who possesses strong analytical and organizational skills. Demonstrated ability to prioritize work demands and meet deadlines. Excellent computer and software knowledge and skills. PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS: Office Based Positions. The employee, either for an office or work from home arrangement, generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours, including weekends and nights to provide coverage. Travel regularly from the office to various work sites or from site to- site frequently. #LI-JS1
The Company supports affirmative action and equal employment opportunity. The Company will provide equal employment in employment practices to all applicants for employment. Employment decisions shall be made without regard to any protected characteristic such as, but not limited to, race, color, religion, gender, age, disability, national origin, ancestry, citizen status, gender identity, sexual orientation, marital status, status in regard to public assistance, disabled veterans, recently separated veterans, Armed Forces service medal veterans and other protected veterans, genetic information and other legally protected classes. Furthermore, the Company is an E-Verify employer. Information provided on this application will not be used for any discriminatory purposes. The Company complies with all applicable federal, state and local non-discrimination laws and regulations. The Company will provide reasonable accommodations in the application or interviewing process. If you need a reasonable accommodation in the application or interviewing process, please contact us.
Little Rock, AR
Direct Hire Position
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Care Manager RN
City, State or Zip Code: Little Rock, AR
Position Type: Direct Hire Position
Date Posted: 12/06/2018