
Patient Care Coordinator
7 days ago
Clinical Nurse Case Manager – USRN
About the Role:The Clinical Nurse Case Manager plays a pivotal role in delivering high-quality patient care while optimizing costs. This critical position involves conducting comprehensive reviews to ensure patients receive the most effective treatment.
- Conduct pre-service, concurrent, retrospective, out-of-network, and appropriateness of treatment setting reviews to guarantee optimal patient outcomes.
- Evaluate service requests to confirm compliance with relevant criteria, medical policy, member eligibility, benefits, and contracts to maintain seamless delivery of healthcare services.
- Utilize client-specific criteria sets for informed decision-making to prioritize patient needs.
This key role includes overseeing medical management review activities, collaborating with clinical reviewers, and ensuring access to necessary healthcare services.
Requirements:- A valid and active USRN license is required.
- A minimum of 1 year of experience in clinical or hospital settings is preferred.
- A RN license and active USRN are mandatory qualifications.
We seek a detail-oriented and dedicated professional to join our team as a Clinical Nurse Case Manager.
Key Skills:Clinical expertise, review skills, problem-solving abilities, and excellent communication skills are essential for this role.
Benefits:Professional growth opportunities, a dynamic work environment, and collaborative team culture make this an attractive opportunity for skilled professionals seeking to advance their careers.
Why Apply:This role offers a challenging and rewarding career path for individuals passionate about delivering exceptional patient care and driving cost-effective solutions.
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