Controls and administrates managed care cases of plan members admitted to the provider plan facilities and/or members utilizing services outside the provider plan facilities. Checks prior authorizations, performs concurrent reviews, indicates the appropriate level of care and utilization of services... [+] More

Controls and administrates managed care cases of plan members admitted to the provider plan facilities and/or members utilizing services outside the provider plan facilities. Checks prior authorizations, performs concurrent reviews, indicates the appropriate level of care and utilization of services needed, develops discharge plans, and ensures quality cost effectiveness. Develops a plan of care for patients from admission to discharge. This managed care position is typically filled by a Registered Nurse with current State license.

Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs. May arrange referrals, consultations, therapeutic services, and confer with other specialists on course of care and treatment. [-] Less

Plans, directs, implements and evaluates appropriate healthcare services in conjunction with the physician treatment plan to ensure that cost effective, quality care is provided.

Case coordination normally includes prospective and retrospective review which includes prior authorization, determining the appropriate level of... [+] More

Plans, directs, implements and evaluates appropriate healthcare services in conjunction with the physician treatment plan to ensure that cost effective, quality care is provided.

Case coordination normally includes prospective and retrospective review which includes prior authorization, determining the appropriate level of care and utilization of services, concurrent review, retrospective review, developing discharge plans, and ensuring quality cost effectiveness. Develops a plan of care for patients from admission to discharge. Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs. Analyzes referred cases for potential case management interventions. Evaluates the effectiveness of alternate care services and ensures that cost effective, quality care is maintained to meet case management objectives. Determines if proposed medical treatment plans meet contract provisions. Authorizes initiation of medical case management. This position typically requires a licensed Registered Nurse with a minimum of five years of relevant nursing and medical case management experience. Certification as a case manager or professional certification in a clinical specialty may also be required. May arrange referrals, consultations, therapeutic services, and confer with other specialist on course of care and treatment. May negotiate fees with providers of medical care, agencies and outside vendors to achieve maximum cost effectiveness. May provide guidance to less experienced case managers. [-] Less

Controls and administrates managed care cases of plan members admitted to the provider plan facilities and/or members utilizing services outside the provider plan facilities. Checks prior authorizations, performs concurrent reviews, indicates the appropriate level of care and utilization of services... [+] More

Controls and administrates managed care cases of plan members admitted to the provider plan facilities and/or members utilizing services outside the provider plan facilities. Checks prior authorizations, performs concurrent reviews, indicates the appropriate level of care and utilization of services needed, develops discharge plans, and ensures quality cost effectiveness. Develops a plan of care for patients from admission to discharge. This managed care position is typically filled by a Registered Nurse with current State license.

Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs. May arrange referrals, consultations, therapeutic services, and confer with other specialists on course of care and treatment. [-] Less

Works with enrollee's providers and caregivers in a health plan to provide intensive, comprehensive case management and increase efficient utilization of services. Typically requires Registered Nurse licensure with patient care experience. Certified Case Manager (CCM) certification may be required.

Identifies chronic... [+] More

Works with enrollee's providers and caregivers in a health plan to provide intensive, comprehensive case management and increase efficient utilization of services. Typically requires Registered Nurse licensure with patient care experience. Certified Case Manager (CCM) certification may be required.

Identifies chronic or catastrophic cases through the case management process and initiates intensive case management according to program guidelines. Evaluates the medical necessity for elective inpatient hospital admission, and authorizes the admission along with the estimated length of stay. Consults with Inpatient Nurse Case Managers regarding existing case management enrollees as well as potential case management enrollees. Screens for the medical necessity of outpatient procedures, home medical equipment, medications, and any other service that requires precertification. Retrospectively reviews medical admission of categories of diseases and procedures. Makes recommendations for standards of care as necessary. Identifies quality indicators through the case management process. May direct abnormal lengths of stay to the Medical Director or Associate Medical Director. May perform on-site reviews for back-up to an Inpatient Nurse Case Manager. [-] Less

Coordinates the delivery of healthcare and social services to the inpatient population while balancing individually identified patient and family, medical, and psychosocial needs with cost-effective and available resources. Manages the inpatient hospital stay of a caseload of patients through coordination... [+] More

Coordinates the delivery of healthcare and social services to the inpatient population while balancing individually identified patient and family, medical, and psychosocial needs with cost-effective and available resources. Manages the inpatient hospital stay of a caseload of patients through coordination with physicians, social workers, nursing staff, and other health professionals. Reports to the Nurse Manager of assigned unit.

Performs utilization review and collaborates with the care team to formulate the discharge plan. Implements a plan of care utilizing approved clinical guidelines to transition and provide continuity of care for the patient to an appropriate lower level of care in collaboration with the hospitalist/physician member team, acute or skilled facility staff, ambulatory care team, and the patient and/or patient's representative from admission through discharge. Interfaces with physicians, nursing staff, and other members of the multidisciplinary and medical records coding staff to ensure appropriate reimbursement is received. Determines medical necessity for admission and continued stay according to specific criteria and regulations in accordance with the Utilization Review Plan. Conducts daily/concurrent reviews of charts to rectify any deviation from compliance. Educates staff, physicians, and other members of the multi-disciplinary team on documentation for compliance. Identifies consistent clinical and operational problem areas and facilitates resolutions through participation in the performance improvement process. Acts as liaison for the management and communication of information with the insurance/managed care companies of the assigned patient population. [-] Less

Plans, directs, implements, and evaluates appropriate healthcare services for Medicare patients in conjunction with Physician's treatment plan to ensure that cost effective, quality care is provided. Typically requires licensure as a Registered Nurse with three years of relevant nursing and... [+] More

Plans, directs, implements, and evaluates appropriate healthcare services for Medicare patients in conjunction with Physician's treatment plan to ensure that cost effective, quality care is provided. Typically requires licensure as a Registered Nurse with three years of relevant nursing and medical case management experience. Certification as a Case Manager or professional certification in a clinical specialty may also be required.

Coordinates cases that normally include prospective and retrospective review and prior authorization, determining the appropriate level of care and utilization of services, concurrent review, retrospective review, developing discharge plans, and ensuring quality cost effectiveness. Develops a plan of care for Medicare patients from admission to discharge. Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs for Medicare patients. Analyzes referred cases for potential case management interventions. Evaluates the effectiveness of alternate care services and ensures that cost effective, quality care is maintained to meet case management objectives. Determines if proposed medical treatment plans meet contract provisions. May arrange referrals, consultations, therapeutic services, and confer with other specialists on course of care and treatment. May negotiate fees with providers of medical care, agencies, and outside vendors to achieve maximum cost effectiveness. [-] Less

Controls and administrates managed care cases of plan members admitted to the provider plan facilities and/or members utilizing services outside the provider plan facilities. Checks prior authorizations, performs concurrent reviews, indicates the appropriate level of care and utilization of services... [+] More

Controls and administrates managed care cases of plan members admitted to the provider plan facilities and/or members utilizing services outside the provider plan facilities. Checks prior authorizations, performs concurrent reviews, indicates the appropriate level of care and utilization of services needed, develops discharge plans, and ensures quality cost effectiveness. Develops a plan of care for patients from admission to discharge. This managed care position is typically filled by a Registered Nurse with current State license.

Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs. May arrange referrals, consultations, therapeutic services, and confer with other specialists on course of care and treatment. [-] Less

Controls and administrates managed care cases of plan members admitted to the provider plan facilities and/or members utilizing services outside the provider plan facilities. Checks prior authorizations, performs concurrent reviews, indicates the appropriate level of care and utilization of services... [+] More

Controls and administrates managed care cases of plan members admitted to the provider plan facilities and/or members utilizing services outside the provider plan facilities. Checks prior authorizations, performs concurrent reviews, indicates the appropriate level of care and utilization of services needed, develops discharge plans, and ensures quality cost effectiveness. Develops a plan of care for patients from admission to discharge. This managed care position is typically filled by a Registered Nurse with current State license.

Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs. May arrange referrals, consultations, therapeutic services, and confer with other specialists on course of care and treatment. [-] Less

Treats and provides nursing care to Critical Care Unit patients in hospital or similar health care facility. Readies equipment and aids physician during treatments and examinations of patients. Administers prescribed medications and treatments in accordance with approved nursing techniques. Observes... [+] More

Treats and provides nursing care to Critical Care Unit patients in hospital or similar health care facility. Readies equipment and aids physician during treatments and examinations of patients. Administers prescribed medications and treatments in accordance with approved nursing techniques. Observes patient, records significant conditions and reactions, and notifies supervisor or physician of patient's condition and reaction to drugs, treatments, and significant incidents. Requires RN license.

Takes temperature, pulse, blood pressure, and other vital signs to detect deviations from normal and assess condition of patient. Lends psychological and emotional support. Answers questions and concerns and provides information to patients and their family members regarding patients' care and treatment. [-] Less

Manages the care of neonatal patients resulting from the childbearing process that requires moderate to complex assessments, interventions, and level of nursing vigilance. Provides tertiary and quaternary care to premature infants and newborns. Works with critically ill neonates with life-threatening... [+] More

Manages the care of neonatal patients resulting from the childbearing process that requires moderate to complex assessments, interventions, and level of nursing vigilance. Provides tertiary and quaternary care to premature infants and newborns. Works with critically ill neonates with life-threatening medical or surgical conditions, such as respiratory distress, birth depression, congenital anomalies, infection and surgical conditions. Provides direct and indirect patient care in collaboration with Neonatologist. Typically requires licensure as a Registered Nurse with ICU or neonatal experience. Resuscitation credentials are typically required.

Conducts an individualized patient assessment, prioritizing the data collection based on the neonatal patient's immediate condition or needs within timeframe specified by the facility's policies, procedures, or protocols. Conducts ongoing assessments as determined by the neonatal patient's condition and the facility's policies, procedures, or protocols and reprioritizes care accordingly. Develops plan of care that is individualized for the neonatal patient reflecting collaboration with other members of the healthcare team. Performs therapeutic nursing interventions as established by individualized plan of care for the neonatal patient and family. Provides individualized patient/family education customized to the neonatal patient and family. Documents patient assessment findings, physical/psychosocial responses to nursing intervention, and progress towards problem resolution. Initiates emergency resuscitative measures according to neonatal resuscitation protocols. Maintains confidentiality in matters related to patient, family, and staff. Reports patient condition to appropriate personnel during each shift. Maintains established policies and procedures, safety, and infection control standards. [-] Less