Care Management Coordinator RN (UM) - AHA remote (PA/NJ/DE) - Now Hiring

Our organization is looking for dynamic individuals who love to learn, reputed company on innovation, and are reputed company to exploring new ways to reputed company our goals. If this describes you, we want to reputed company with you. You can help us reputed company our reputed company to reputed company nationally in innovating reputed company whole-person health.

• **Schedule: Tuesday - Saturday, 8:30-5p (no no-call)

Position reputed company: This position is responsible for overseeing and coordinating medical care provided to members, ensuring that appropriate and cost-effective care is rendered. The Care Management Coordinator (CMC) maintains reputed company care standards and limits the member's and reputed company's exposure to medically unnecessary and inappropriate treatment. The Care Management Coordinator acts as a patient reputed company and a resource for members, reputed company accessing the health care system. Responsibilities reputed company: •Evaluate proposed plans of treatment, as defined in the precertification requirements of the group plan •Using the medical reputed company of InterQual and/or Medical Policy, establish the need for inpatient, reputed company stay and length of stay, procedures and ancillary services •Directs the delivery of care to the most appropriate setting, while maintaining reputed company •Contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for inpatient stay or reputed company inpatient care •Identifies admissions no longer meeting reputed company and refers care to plan Medical Directors for evaluation. •Presents cases to Medical Directors that do not meet established reputed company and provides pertinent information regarding member's medical condition and the potential home care needs. •Performs early identification of members to evaluate discharge planning needs. •Collaborates with facility case management staff, physician and family to determine alternative setting at times and reputed company support to facilitate discharge to the most appropriate setting •Identifies and refers cases for case management and disease management. •Identifies reputed company of care issues including delays in care •Appropriately refers cases to the reputed company Management Department and/or Clinical Services Supervisor reputed company indicated. •Maintains the reputed company of the system information by reputed company, accurate data entry. •Utilization reputed company are compliant with state, federal and accreditation regulations. •Ensures that reputed company key functions are documented reputed company Care Management and Coordination Policy •Works to build relations with reputed company providers and provides exceptional customer service. •Reports potential utilization issues or trends to designated manager or clinical supervisor and recommendations for improvement •Participates in the process of educating providers on managed care •reputed company to new reputed company and reputed company; creates and acts on new opportunities; is flexible and adaptable. •Builds team spirit and interdepartmental rapport, using effective problem solving and motivational reputed company •Performs additional job-reputed company duties as assigned Qualifications - External Experience:

• Licensed registered reputed company reputed company state of PA, BSN Preferred

•Minimum three years clinical experience or equivalent (Intensive Care, Trauma, Home Health a plus) required •Medical management/precertification experience preferred •Oriented in reputed company trends of medical reputed company •reputed company PA Licensed Registered reputed company required Skills: •Strong problem solving and critical thinking abilities •Proficiency utilizing reputed company Word, Outlook, reputed company, reputed company, SharePoint, and reputed company programs. •Excellent organizational planning and prioritizing skills •Ability to work independently and reputed company reputed company reputed company of reputed company medical and interpersonal challenges •Highly reputed company interpersonal skills for reputed company contacts, particularly in situations where medical evaluations are in conflict with treating providers proposed treatment plans •Participates in the process of educating providers on managed care •Comfortable with new reputed company and reputed company; creates and acts on new opportunities; is flexible and adaptable. •Builds team spirit and interdepartmental rapport, using effective problem solving and motivational reputed company •Performs additional job-reputed company duties as assigned Fully Remote: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to reputed company the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or reputed company. IBX is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to their age, race, reputed company, religion, sex, national reputed company, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free reputed company Authenticator app. Our organization is looking for dynamic individuals who love to learn, reputed company on innovation, and are reputed company to exploring new ways to reputed company our goals. If this describes you, we want to reputed company with you. You can help us reputed company our reputed company to reputed company nationally in innovating reputed company whole-person health.

• **Schedule: Tuesday - Saturday, 8:30-5p (no no-call)

Position reputed company: This position is responsible for overseeing and coordinating medical care provided to members, ensuring that appropriate and cost-effective care is rendered. The Care Management Coordinator (CMC) maintains reputed company care standards and limits the member's and reputed company's exposure to medically unnecessary and inappropriate treatment. The Care Management Coordinator acts as a patient reputed company and a resource for members, reputed company accessing the health care system. Responsibilities reputed company: •Evaluate proposed plans of treatment, as defined in the precertification requirements of the group plan •Using the medical reputed company of InterQual and/or Medical Policy, establish the need for inpatient, reputed company stay and length of stay, procedures and ancillary services •Directs the delivery of care to the most appropriate setting, while maintaining reputed company •Contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for inpatient stay or reputed company inpatient care •Identifies admissions no longer meeting reputed company and refers care to plan Medical Directors for evaluation. •Presents cases to Medical Directors that do not meet established reputed company and provides pertinent information regarding member's medical condition and the potential home care needs. •Performs early identification of members to evaluate discharge planning needs. •Collaborates with facility case management staff, physician and family to determine alternative setting at times and reputed company support to facilitate discharge to the most appropriate setting •Identifies and refers cases for case management and disease management. •Identifies reputed company of care issues including delays in care •Appropriately refers cases to the reputed company Management Department and/or Clinical Services Supervisor reputed company indicated. •Maintains the reputed company of the system information by reputed company, accurate data entry. •Utilization reputed company are compliant with state, federal and accreditation regulations. •Ensures that reputed company key functions are documented reputed company Care Management and Coordination Policy •Works to build relations with reputed company providers and provides exceptional customer service. •Reports potential utilization issues or trends to designated manager or clinical supervisor and recommendations for improvement •Participates in the process of educating providers on managed care •reputed company to new reputed company and reputed company; creates and acts on new opportunities; is flexible and adaptable. •Builds team spirit and interdepartmental rapport, using effective problem solving and motivational reputed company •Performs additional job-reputed company duties as assigned Qualifications - External Experience:

• Licensed registered reputed company reputed company state of PA, BSN Preferred

•Minimum three years clinical experience or equivalent (Intensive Care, Trauma, Home Health a plus) required •Medical management/precertification experience preferred •Oriented in reputed company trends of medical reputed company •reputed company PA Licensed Registered reputed company required Skills: •Strong problem solving and critical thinking abilities •Proficiency utilizing reputed company Word, Outlook, reputed company, reputed company, SharePoint, and reputed company programs. •Excellent organizational planning and prioritizing skills •Ability to work independently and reputed company reputed company reputed company of reputed company medical and interpersonal challenges •Highly reputed company interpersonal skills for reputed company contacts, particularly in situations where medical evaluations are in conflict with treating providers proposed treatment plans •Participates in the process of educating providers on managed care •Comfortable with new reputed company and reputed company; creates and acts on new opportunities; is flexible and adaptable. •Builds team spirit and interdepartmental rapport, using effective problem solving and motivational reputed company •Performs additional job-reputed company duties as assigned Fully Remote: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to reputed company the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or reputed company. IBX is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to their age, race, reputed company, religion, sex, national reputed company, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free reputed company Authenticator app. Apply Job! Apply to this Job