Talent.com
Case Management Nurse

Case Management Nurse

US Tech SolutionsColumbia, SC, US
18 hours ago
Job type
  • Full-time
Job description

Job Description

Duration : 4+ months (Possible contract to hire)

Work Schedule : Mon- Fri (8am-4.30pm)

Job Description :

  • Skill sets / qualities : Case management experience preferred, Transition of Care experience preferred, Prior experience working for a health insurance company and / or with Medicare population
  • A typical day would like in this role : Telephonic outreach to members for various reasons : Follow-up calls to members after an ER visit and / or hospital stay. Educating members on their disease process / medications. Communicating with hospital case managers to ensure a safe discharge and prevent readmission after a hospital stay
  • Flexibility, dependability, Strong communication skills must be comfortable talking on the phone, Knowledge of MS Office (Outlook, Teams, Excel), Ability to work independently
  • Our team comprises a diverse group of passionate, collaborative individuals working together to support members and one another. Although we are remote, we are always available to assist each other.

Responsibilities :

  • Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge / analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Provides active case management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals.
  • Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high risk pregnancy or other at-risk conditions that consist of : intensive assessment / evaluation of condition, at risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Performs medical or behavioral review / authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.).
  • Participates in data collection / input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but isnot limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). Participates in direct intervention / patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and / or health and disease management programs. Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and / or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
  • Experience :

  • 4 years clinical experience.
  • Skills :

  • Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
  • Required Software and Tools : Microsoft Office. Preferred Skills and Abilities : Working knowledge of spreadsheet, database software. Knowledge of contract language and application. Thorough knowledge / understanding of claims / coding analysis / requirements / processes. Preferred Software and Other Tools : Working knowledge of Microsoft Excel, Access or other spreadsheet / database software. Work Environment : Typical office environment. Employee may work from one's / out of one's home. May involve some travel within one's community.
  • Education :

  • Associate Degree - Associate Degree - Nursing, or Graduate of Accredited School of Nursing.
  • Required License / Certificate : Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • About US Tech Solutions :

    US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.

    US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

    Recruiter's detail : Name : Vivek Kumar

    Email : Vivek.kumar@ustechsolutionsinc.com

    Internal ID : 25-49476

    Create a job alert for this search

    Nurse Case Management • Columbia, SC, US

    Related jobs
    • Promoted
    Medical Case Manager I

    Medical Case Manager I

    CAN Community HealthColumbia, SC, United States
    Full-time
    CAN Community Healthis the nation's premier resource in ending epidemics with a mission of empowering wellness, has an exciting opportunity for a Medical Case Manager 1 in our clinic in Columbia, S...Show moreLast updated: 14 days ago
    • Promoted
    Registered Nurse (RN) - Case Manager

    Registered Nurse (RN) - Case Manager

    UVA HealthColumbia, SC, US
    Full-time
    RELOCATE TO VIRGINIA OPPORTUNITY.Join our esteemed team of healthcare professionals committed to advancing healthcare through cutting-edge research, comprehensive training, and compassionate care.U...Show moreLast updated: 3 days ago
    • Promoted
    Travel Nurse RN - Med Surg - $2,110 per week

    Travel Nurse RN - Med Surg - $2,110 per week

    Malone Healthcare - NursingColumbia, SC, United States
    Full-time
    Malone Healthcare - Nursing is seeking a travel nurse RN Med Surg for a travel nursing job in Columbia, Colorado.Job Description & Requirements. Travel Nurse Job Description – Day Shift (3x12s) 🕒 S...Show moreLast updated: 11 days ago
    • Promoted
    Travel Nurse RN - Med Surg - $1,796 per week

    Travel Nurse RN - Med Surg - $1,796 per week

    BesticaCamden, SC, United States
    Full-time
    Bestica is seeking a travel nurse RN Med Surg for a travel nursing job in Camden, South Carolina.Job Description & Requirements. Position / Specialty : Med Surg RN.Weekend REQ : Every other weekend.Wi...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ED - Emergency Department

    Travel Nurse RN - ED - Emergency Department

    Go HealthcareWinnsboro, SC, US
    Full-time
    Go Healthcare is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Winnsboro, South Carolina. Job Description & Requirements.Pay package is based on 12 hour shifts ...Show moreLast updated: 30+ days ago
    • Promoted
    Local Contract Nurse Practitioner - Clinic Family Practice

    Local Contract Nurse Practitioner - Clinic Family Practice

    Apidel TechnologiesLexington, SC, US
    Permanent +1
    Apidel Technologies is seeking a Nurse Practitioner Clinic Family Practice for a local contract job in Lexington, South Carolina. Job Description & Requirements.This is a Local Contract job in L...Show moreLast updated: 1 day ago
    • Promoted
    Travel Nurse RN - ED - Emergency Department

    Travel Nurse RN - ED - Emergency Department

    ALOIS HealthcareWinnsboro, SC, US
    Full-time
    ALOIS Healthcare is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Winnsboro, South Carolina. Job Description & Requirements.An Emergency Room Nurse is primarily...Show moreLast updated: 30+ days ago
    • Promoted
    Assistant Nurse Manager (ANM) - Medical Oncology & Infusion, FT, Days

    Assistant Nurse Manager (ANM) - Medical Oncology & Infusion, FT, Days

    Prisma HealthColumbia, SC, United States
    Full-time
    In collaboration with the nurse manager, supervises staff and unit operations and provides direct patient care.Supervises care provided by staff to ensure the delivery of safe and quality patient c...Show moreLast updated: 17 days ago
    • Promoted
    Travel Nurse RN - Long Term Acute Care - $2,111 per week

    Travel Nurse RN - Long Term Acute Care - $2,111 per week

    Go HealthcareColumbia, SC, United States
    Full-time
    Go Healthcare is seeking a travel nurse RN Long Term Acute Care for a travel nursing job in Columbia, South Carolina.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hou...Show moreLast updated: 23 days ago
    • Promoted
    Assistant Nurse Manager (ANM) - Acute Care, Med Surg - Medical Telemetry, FT, Variable

    Assistant Nurse Manager (ANM) - Acute Care, Med Surg - Medical Telemetry, FT, Variable

    Prisma HealthColumbia, SC, United States
    Full-time
    In collaboration with the nurse manager, supervises staff and unit operations and provides direct patient care.Supervises care provided by staff to ensure the delivery of safe and quality patient c...Show moreLast updated: 30+ days ago
    • Promoted
    Local Contract Nurse Practitioner - Clinic Family Practice - $72-78 per hour

    Local Contract Nurse Practitioner - Clinic Family Practice - $72-78 per hour

    Apidel TechnologiesLexington, SC, US
    Permanent +1
    Apidel Technologies is seeking a Nurse Practitioner Clinic Family Practice for a local contract job in Lexington, South Carolina. Job Description & Requirements.This is a Local Contract job in L...Show moreLast updated: 1 day ago
    • Promoted
    Travel Nurse RN - ED - Emergency Department

    Travel Nurse RN - ED - Emergency Department

    TRS HealthcareWinnsboro, SC, US
    Full-time
    TRS Healthcare is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Winnsboro, South Carolina. Job Description & Requirements.TRS Healthcare Job ID #1381859.Pay pac...Show moreLast updated: 12 days ago
    • Promoted
    Travel Nurse RN - ED - Emergency Department

    Travel Nurse RN - ED - Emergency Department

    Uniti MedWinnsboro, SC, US
    Full-time
    Uniti Med is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Winnsboro, South Carolina.Job Description & Requirements. Uniti Med is looking for a Travel Emergency...Show moreLast updated: 30+ days ago
    • Promoted
    Registered Nurse (RN)-Hospital Case Manager, PRN, Days

    Registered Nurse (RN)-Hospital Case Manager, PRN, Days

    Prisma HealthColumbia, SC, United States
    Full-time
    The Hospital Care Manager (HCM) is an integral care team partner that focuses on patient engagement and activation, has primary accountability for patients' care transition out of the acute care se...Show moreLast updated: 30+ days ago
    • Promoted
    RN-Hospital Case Manager, Full-Time, Days

    RN-Hospital Case Manager, Full-Time, Days

    Prisma HealthColumbia, SC, United States
    Full-time
    The Hospital Case Manager (HCM) provides case management service for hospital patients, including, but not limited to, utilization management to ensure efficient, cost-effective patient progression...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - Telemetry - $1,803 per week

    Travel Nurse RN - Telemetry - $1,803 per week

    BesticaColumbia, SC, US
    Full-time
    Bestica is seeking a travel nurse RN Telemetry for a travel nursing job in Columbia, South Carolina.Job Description & Requirements. Experience and Certification Required : .Certification Required : ...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ED - Emergency Department

    Travel Nurse RN - ED - Emergency Department

    Travel Nurses, Inc.Winnsboro, SC, US
    Full-time
    RN ED - Emergency Department for a travel nursing job in Winnsboro, South Carolina.Job Description & Requirements.Pay package is based on 12 hour shifts and 36 hours per week (subject to confir...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Nurse Manager ($5K Sign On Bonus & $15K Retention Bonus)

    Nurse Manager ($5K Sign On Bonus & $15K Retention Bonus)

    AIDS Healthcare FoundationColumbia, SC, US
    Full-time
    AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!.Does the idea of doing something that really makes a difference in people’s lives while being well-compensated i...Show moreLast updated: 20 hours ago