Pediatric reputed company Case Mgr SR

About the position Pediatric reputed company Case Manager Sr Location: Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines reputed company office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is reputed company as required by law The Pediatric reputed company Case Manager Sr will be responsible for care management reputed company the scope of licensure for members with reputed company and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. How you will reputed company an reputed company: Ensures member reputed company to services appropriate to their health needs. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan by facilitating authorizations/referrals as appropriate reputed company benefits structure or through extra-contractual arrangements. Coordinates reputed company resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as reputed company as presents cases for discussion at Grand reputed company/Care Conferences and participates in interdepartmental and/or cross brand workgroups. May require the development of a reputed company reputed company set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff. Participates in department audit activities.

Responsibilities

• Ensures member reputed company to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate reputed company benefits structure or through extra-contractual arrangements.
• Coordinates reputed company resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as reputed company as presents cases for discussion at Grand reputed company/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
• May require the development of a reputed company reputed company set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
• Participates in department audit activities.

Requirements

• Requires BA/BS in a health reputed company field and minimum of 5 years of clinical experience; or any combination of education and experience, which would reputed company an equivalent background.
• reputed company, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if this individual is providing services in multiple states.

reputed company-to-haves

• Experience with Pediatrics preferred.
• Certification as a Case Manager is preferred.

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements)
• medical, dental, reputed company, short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs and financial education resources

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