Registered Nurse

Duration: 06 Months.

• Virginia State RN LICENSE needed.
• Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.
• Determines medical necessity/ appropriateness Facilitates optimal outcomes Identifies and follow through with continuous quality/ compliance opportunities.
• May also include identification of aberrances and initiation of corrective action Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy Optimize total costs Implementation and evaluation of policy based on usage and program directives Educate/empower colleagues at all levels to enable decision making at most appropriate level.

Job Duties:

• This is a telework role that will require 50-75% Travel within the Tidewater Region of VA (Virginia Beach, Norfolk, Chesapeake, Portsmouth, and surrounding areas).
• Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
• Develops a proactive course of action to address issues presented to enhance the short and long- term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
• Services strategies policies and programs are comprised of network management and clinical coverage policies.
• Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to organization’s programs and plans.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
• Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member’s level of work capacity and related restrictions/limitations.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents case at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
• Typical office working environment with productivity and quality expectations.
• Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
• Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Effective communication skills, both verbal and written.

Qualifications / Experience:

• Must reside in Virginia.
• RN with current unrestricted Virginia state licensure
• 3+ years of clinical experience (i.e. med surg, behavioral health, etc.)
• Reliable transportation required. Mileage is reimbursed per our company expense reimbursement.
• Willing and able to travel 50-75% within the Tidewater region of VA.

Preferred Qualifications:

• • 5+ years of clinical experience
• • Behavioral health or substance abuse experience
• • Case Management experience in an integrated model
• • Bilingual preferred.

Education:

• Associate's degree or bachelor’s degree in nursing required.

Shift Timing:

• Work schedule: Monday - Friday 8am - 5pm EST.