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Registered Nurse - Case Manager

Company: TotalMed, TotalMed
Location: Potomac
Posted on: April 30, 2021

Job Description:

Remote from home in response to COVID, Candidates must be local to Washington, DC area.

Hours: Monday-Friday 8am-5pm

Job Summary:

Coordinates, negotiates, procures, and manages care of patients to facilitate cost effective care and patient 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.

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 contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
  • Acts as an advocate while assisting members 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 as member’s acuity necessitate.

Keywords: TotalMed, TotalMed, Potomac , Registered Nurse - Case Manager, Other , Potomac, Maryland

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