Nurse Care Manager

3 days ago

Manila, National Capital Region, Philippines Private Advertiser Full time

Responsible for collaborating with healthcare providers and/or consumers to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs.

Primary duties may include, but are not limited to:

  1. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
  2. Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
  3. Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
  4. Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan.
  5. Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

Minimum Requirements:

  • Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, active valid unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states.
  • Home health/discharge planning experience preferred. AS or BS in nursing preferred. Certification as a Case Manager is preferred.
  • For URAC accredited areas, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice.
  • Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background. Multi-state licensure is required if this individual is providing services in multiple states.
  • Certification as a Case Manager or a BS in a health or human services related field also preferred.
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