RN Case Manager - TPA

Location: Tacoma, WA
Date Posted: 02-01-2018
RN Case Manager - Managed Care
Tacoma, WA

Your Job Summary:
As a member of the medical management team, the RN Case Manager plays an integral part in the coordination of care assessing the member’s condition and providing them the necessary resources, options, and coordination for a healthy care outcome. The focus of this position is to conduct telephonic and in-person surveys to identify vulnerable populations and special needs members through the completion of health screens and other resources.  Once identified, the nurse will assist in connecting members to appropriate services while acting as a clinical resource to complex medical cases and individual service plans.

Your Reward:  
Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members.  The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance member’s ability to manage their own health.

Your Background:   

Valid, unrestricted state Registered Nurse (R.N.) license.
Roughly 3-4 years nursing experience in an acute care hospital.
Around 1-3 years prior experience at a Managed Care Organization is preferred (Health Plan, IPA, MSO, TPA, etc).
Demonstrates the ability to triage and apply critical thinking skills.
Experience working with Federal and State assistance programs (Medicare/Medicaid/etc)
Computer savvy (MS Word & Excel) and typing skills are necessary.
Strong oral and written communication skills: Ability to interact within all levels of the organization and with external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.

Your Duties:
The RN Case Manager will serve as the initial triage nurse for the case management needs of members. They will collaborate effectively with an interdisciplinary team to establish an individualized plan of care for members. A strong emphasis is placed on Wellness, Disease Management and patient/member education to ensure compliance with the plan of care and prevention of complications with various ailments. The Nurse will link the member with other medical management staff that can develop interventions and processes to assist the Health Plan member in meeting short and long term plan of care goals. Communication of patient needs will be conducted through timely and accurate data entry into designated care management applications. They will participate in the development of appropriate QI processes, establishing and monitoring indicators. Utilizing their knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms, the Nurse will help guide members to specific physicians / provider groups in their awareness of preferred contracts, providers, and facilities. They will coordinate the approved services with all provider staff under the specific direction of the Medical Director or Manager of Medical Management.
CareNational Healthcare Services
480.478.1635 (CALL – TEXT – FAX)

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