Nurse Care Coordinator Role
1 day ago
The role of a Clinical Nurse Case Manager involves providing high-quality, cost-effective healthcare services to patients. The nurse case manager will conduct thorough reviews of patient information against established criteria and guidelines to ensure compliance with medical policies and member eligibility.
Key Responsibilities:- Conducting UM pre-service, concurrent, retrospective, out-of-network, and appropriateness of treatment setting reviews.
- Reviewing service requests for compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
- Utilizing client-specific criteria sets and applicable clinical guidelines for decision making.
- Responsible for conducting medical management review activities that require the review of clinical information against client-specific criteria.
- Ensuring member access to medically necessary, quality healthcare in a cost-effective setting according to the contract.
- Collaborating with clinical reviewers and U.S.-licensed medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.
Required Skills and Qualifications
- Active and non-active USRN license.
- At least 1 year of clinical or hospital experience.
- USRN with RN license.
This position offers a direct employment opportunity with no bond. You have an option to choose the company that fits you best through partnerships with multiple companies. Work set up is flexible, allowing for work from home opportunities.
Job RequirementsThis is a challenging and rewarding role for experienced nurses who are passionate about delivering high-quality patient care. If you are a motivated and detail-oriented individual with excellent communication skills, we encourage you to apply for this exciting opportunity.
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