RN CASE MANAGER PCHP

 PCHP Commercial Medical Mgmt

  Monday-Friday 8:30a-5:00p

  • REQUIRED: RN
  • 3 or More Years of Experience Required
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    JOB SUMMARY:                                                                                                                                

    Responsible for the day to day implementation of the case management programs. Assure effective interface and cooperation with other departments in order to implement effective patient care and achieve medical management goals.

     

    ESSENTIAL FUNCTIONS/TYPICAL TASKS:

    These are intended only as illustrations of the various types of work performed. The omission of specific duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.

     

    Ø  Implements departmental policy and procedures to assure effective case management program under the direction of the Piedmont Chief Medical Officer and Medical Directors

    Ø  Performs utilization review duties as assigned

    Ø  Identifies members who qualify for case management

    Ø  Assists with discharge planning for members changing levels of care

    Ø  Institutes a care management plan

    Ø  Completes comprehensive assessments for members enrolled in case management in order to institute a care management plan

    Ø  Interacts with network physicians and facilities to assist with care coordination

    Ø  Other duties as assigned

     

    KNOWLEDGE, SKILLS AND ABILITIES: 

    Must have strong oral and written communication and organizational skills; must be able to work effectively with all levels of employees and providers; must maintain confidentiality; must be a team player; and must have ability to prioritize and handle multiple projects.

     

    EDUCATION AND EXPERIENCE:

    Active  Virginia license to practice as a Registered Nurse

    Minimum 3-5 years clinical nursing

    MS Office: Word, Excel, Outlook

    Excellent communication and documentation skills


    PHYSICAL DEMANDS DISCLAIMER

    Job Description will be reviewed at time of interview.


    The physical demands outlined in the job description must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Some job positions require a Job Function Match test (physical demands test) in which the applicant must meet all physical demand requirements for the position.