Registered Nurse - Case Manager
Company: TotalMed, TotalMed
Posted on: April 30, 2021
Remote from home in response to COVID, Candidates must
be local to Washington, DC area.
Hours: Monday-Friday 8am-5pm
Coordinates, negotiates, procures, and manages care of patients
to facilitate cost effective care and patient satisfaction.
Facilitates the continuum of care, works collaboratively with
interdisciplinary staff, internal and external to the organization.
Responsible for carrying a complex case management case load,
ownership of a case management program(s), pre- authorization
reviews to provide Medically Necessary, timely and quality health
care services in the most cost-effective manner and pharmacy
Primary Duties and Responsibilities
- Contributes to the achievement of established department goals
and objectives and adheres to department policies, procedures,
quality standards, and safety standards. Complies with governmental
and accreditation regulations.
- Actively develops and manages complex case management cases and
develops individualized plans of care according to NCQA standards/
guidelines and the District of Columbia Contract.
- Acts as a liaison to contracted vendors to facilitate care.
Identifies gaps in contracted services and develops a plan to
- Acts as an advocate while assisting members to coordinate and
gain access to medical, psychiatric, psychosocial and other
essential services to meet their healthcare needs. Authorizes and
monitors covered services according to policy.
- Assists hospital case management staff with discharge planning,
if applicable. Makes recommendation to alternate tier of Case
Management programs as member’s acuity necessitate.
Keywords: TotalMed, TotalMed, Bethesda , Registered Nurse - Case Manager, Other , Bethesda, Maryland
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