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REMOTE Nurse Case Manager

As an integral part of the medical management model you will contribute to the optimization efforts of case management processes and play a vital role in maintaining the integrity of each client's healthcare plan. The company helps employers administer their own health plans.

* Provide ongoing member management, including making informed case determinations, assessment of ongoing treatment plans, and collaborating with member and provider teams to ensure maximum quality health outcomes 
* Coordinate with providers, facilities, outpatient services, and other community resources to deliver exceptional client service, intervening as indicated to drive the appropriate delivery of care 
* Proactively provide education and support to members related to their health care needs 
* Identify and initiate negotiations for cost savings, quality care improvements, and benefit adjustments, as indicated, to ensure quality, cost-effective care across the healthcare continuum 
* Play an integral collaborative role with Employer Groups, Account Managers, Stop Loss Carriers, and Claims Analysts 
* Assist members in transitioning levels of care to ensure best delivery practices 
* Evaluate outcomes and cost avoidance/ savings strategies and maintain rigorous valid data to ensure accurate client reporting

Must haves:
Current WA State Registered Nurse clinical license or equivalent 
* 3-5 years of clinical experience, preferably in the acute care setting
* Utilization Review/Management experience

* Strong experience in a clinical practice with diverse diagnoses 
* Strong problem solving and critical thinking skills 
* Knowledge of Case Management and Utilization Review processes preferred 
* Excellent, client-facing verbal and written communication skills 
* Behavioral health experience preferred 
* Proficiency with Microsoft Office applications (Outlook and Word) and DOSS 
* Motivated self-starter with the ability to work independently 
* Enjoys the pace and rhythm of a deadline-oriented environment utilizing strong prioritization skills 

*This position will be in-house for 1 month (training period) and then will be a flexible schedule/work from home option

REMOTE Nurse Case Manager

Seattle, WA
Contract / Temporary

Published on 03-04-2019