Nurse Case Manager

StarMed Healthcare is searching for a devoted RN case manager to coordinate and advocate for our patients’ care.

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.