RN Case Manager

We are seeking an experienced RN Case Manager for our Health Services Department in our Birmingham location.

 

The RN Case Manager will be responsible for coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of alternative treatment plans that address individual needs of the member, their benefit plan and community resources.

 

Responsibilities:Identifies high-risk/high-cost patients for possible case management interventionInterfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning and alternative treatment plan developmentWorks closely with the inpatient team to identify discharge planning issuesInitiates contact with patient/family, physician and health care providers/suppliers to discuss the alternative treatment plan.  Conducts on-site evaluations as is necessaryCollaborates with the attending physician to achieve identified patient outcomesCoordinates the treatment plan to accommodate the Health Services needs of the patient, benefit availability, and community resourcesMonitors and evaluates (at least every 30 days) that the plan remains appropriate.  Extends, revises, or closes treatment plans as is appropriateRefers questionable case management cases or requests to the Medical DirectorCommunicates denial decisions to all appropriate parties following established guidelinesEvaluates each case for quality of care, documents quality issues, and appropriately refers cases with questionable quality of care to the Manager of Quality ImprovementProduces monthly reports that update the patient?s progress and submits the reports in a timely fashion to the appropriate party (patient, family, physician, payer)Communicates with all departments to resolve issues or document trendsUnderstands and follows administrative guidelines (policy and procedure) of the unitAttends and actively participates in staff meetingsPerforms other duties as assigned

 

Job Related Skills:Verbal and written communication skillsInterpersonal skillsBasic mathematical and statistical abilityOrganizational skillsTyping or basic computer knowledgeKnowledge of utilization review requirements and proceduresKnowledge of current health care practices and appropriate treatmentsKnowledge of community resources

 

Requirements include:

? Current Licensure as a practical nurse, registered nurse, or Social Worker in the State of Alabama

? Associates Degree or diploma in Nursing preferred

? 2 years recent experience in a case management or utilization management position preferred

? 5 years recent experience in an acute-care environment preferred

? Prefer Certified Case Manager

 

HealthSpring of Alabama offers a competitive salary and a full range of benefits.

 

Please visit http://healthspring.mywebinterview.com/app/AL to complete an online application.

 

Everyone must complete an online application.

 

 

Select Department:  Health Services

Select Position: RN Case Manager

 

 Attach resume

 

Include salary history/requirement

 

No phone calls accepted