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Case Management Nurse

Company: Aerotek
Location: Chattanooga
Posted on: January 15, 2022

Job Description:

Actalent is currently partnering with an insurance provider in the area in need of a Registered Nurse to join their team for a remote Case Manager role. Candidates are required to be located in TN, KY, or GA. Please see below for details and qualifications!Description:

  • The case manager will be reviewing insurance member files for care coordination; reviewing up to 25 charts/day
  • Responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources
  • Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources
  • Works with medical directors in interpreting appropriateness of care and accurate claims payment
  • Primary duties may include, but are not limited to:
    • Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
    • Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract
    • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process
    • Collaborates with providers to assess members needs for early identification of and proactive planning for discharge planningSkills & Qualifications:
      • TN or multi-state RN licensure required
      • NICU, Pediatric, acute adult inpatient, sub acute pediatric, OB/maternal child health experience, high risk OB population experience required
      • Prior utilization management experience preferred
      • Fundamental/basic computer skillsExperience Level:
        • Intermediate Level About Actalent:Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. Were supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Keywords: Aerotek, Chattanooga , Case Management Nurse, Executive , Chattanooga, Tennessee

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