Nurse Case Manager
NURSE CASE MANAGER
Charlotte, North Carolina
$30-$35 per hour based upon experience
Full Job Description
StarMed Healthcare is searching for a devoted RN case manager to coordinate and advocate for our patients’ care. They help determine the type of care needed and the steps that must be taken to ensure that the patient receives that care. You should remain in contact with patients during these and subsequent processes.
To ensure success as an RN case manager, you should be able to remove pertinent logistical burdens from patients to ensure that they are afforded the time and space to focus on their health. Ultimately, a remarkable RN case manager will establish warm and meaningful ties with each patient and their family.
Responsibilities
Use clinical tools, data and other information to complete assessments of patient needs
Create individualized and comprehensive case management and treatment plans
Implement care plan by facilitating authorization/referrals as appropriate within benefits structure or through extra-contractual arrangements
Coordinate internal and external resources to meet identified needs
Negotiate rates of reimbursement as applicable
Assist in problem solving with providers, claims or service issues
Communicate one on one with providers and appropriate staff to determine patient needs
Assist in coordinating the patients care by effectively collaborating with the providers, care team members, attorneys, employer occupational health divisions to provide high quality care and optimize the appropriate use of all health resources
Work in compliance with ACO partners for the purpose of facilitating the implementation of care plans, missed care opportunities, necessary referrals and medication compliance, and ensuring that the medical care received by the patient is cost-efficient and medically appropriate.
Work in compliance with ACO partners for the purpose of facilitating the implementation of care plans, missed care opportunities, necessary referrals and medication compliance, and ensuring that the medical care received by the patient is cost-efficient and medically appropriate.
Work in compliance with NC Workers Compensation Act for the purpose of facilitating the recovery of the injured worker, and ensuring that the medical care received by the injured worker is cost-efficient and medically appropriate
Comply with and apply NC Workers Compensation laws and regulations when consulting and performing routine case management tasks for these specific injured patients
Work with patient/employer Workers Compensation insurance personnel, including but not limited to; Insurance appointed RN Case Manager, insurance adjuster, patient/employer attorney(s) and other legal team members
Determine insurance eligibility for various treatments and treatment programs
Clearly explain the reason for prescribed treatments and treatment plans to patients
Educate patients on benefits, services and other resources, including payment options
Communicate with patients, physicians and insurance companies to secure successful outcomes
Document complex medical information to outline and improve health results
Follow case and quality management processes in compliance with regulatory guidelines and company procedures
Track and report Corporate Wellness Program participation with employer(s) specific program requirements
Assist with quality measures for employer-employee chronic conditions, compliance with wellness program goals, education provided when requested to generate a positive experience for all parties involved
Maintain appropriate relationships with all parties involved and provide appropriate communication as required and when requested
Maintain HIPAA compliance with all parties involved
Requirements
Associate’s or bachelor’s degree in nursing, with a bachelor’s degree preferred
Active nursing license in the state in which you will be based
Clinical knowledge of chronic conditions, such as diabetes and congestive heart failure
Strong written and verbal communication skills with patients, physicians and other stakeholders
Demonstrated ability to assess and respond to patient and family needs in a timely manner
General knowledge of case management practices, including familiarity with relevant products and services
Basic computer skills, including working knowledge of the Microsoft Office suite
Experience in establishing professional and collaborative relationships with patients, doctors and insurance providers
Certification as a diabetes educator, nutritionist, physical therapist or other specialty is a plus
Preferred experience working with NC Workers Compensation laws and regulations
We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.