Case Management Nurse
- Full-time
Job Title : RN Case Manager
Location : Washington, District of Columbia, 20008
Contract duration : 13 weeks
Shift : 5X8 -hours
Schedule : Days
Key Responsibilities :
Conduct comprehensive assessments for enrollees in the Washington, DC area.
Develop individualized care plans addressing medical, behavioral, and social needs.
Coordinate care transitions, discharge planning, and follow-up appointments.
Manage ongoing patient needs using EMR systems such as GuidingCare or HealthEdge .
Utilize InterQual and Milliman criteria to support clinical decision-making.
Communicate effectively with patients, families, physicians, and interdisciplinary teams.
Monitor and document patient progress according to established protocols.
Ensure compliance with regulatory and accreditation standards including DOH DRG , HEDIS , NCQA , OSHA , and JCC .
Apply knowledge of CPT codes and reimbursement criteria to support care management activities.
Participate in quality improvement and population health initiatives.
Requirements : RN License
Certifications : Current BLS required.
Acute Hospital
Long Term Acute Care / Rehab / Skilled Nursing
Admission Criteria, Care Coordination, or Discharge Planning
Interested? Apply now!
About Pride Health :
Pride Health is Pride Global healthcare staffing branch, providing recruitment solutions for healthcare professionals and the industry at large since 2010.
Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.
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