This position is required to perform case management activities for health plan members. The activities will include assessing needs, developing a patient-centered care plan, monitoring outcomes, and coordinating interdisciplinary approaches and services. These functions may be performed onsite and/or telephonic. This position works closely with the Health Services Manager and the Medical Director to evaluate, monitor and assure coordination of services, health care coaching and navigation as it relates to condition management, quality, continuity and cost effectiveness. This position is responsible for managing utilization, gaps in care, and performing necessary interventions for positive health outcomes.
What will be my duties and responsibilities in this job?
Performs assessment, screening, and evaluation of patient’s needs.
Develops patient-centered care plans
Facilitates coordination of care for members in various levels of care to ensure appropriateness and medical necessity.
Maintains knowledge of the case management standards of practice, regulatory requirements (i.e. URAC), and state requirements for utilization and case management activities.
Initiates case planning meetings and uses an interdisciplinary process in which all members of the health care team collaborate with patients and their families to anticipate needs.
Communicates with physicians, providers, family members/care givers, and patients.
Utilizes community resources as deemed necessary and maintains on-going relationships with above.
Documents care management activities in managed care operating systems
What are the requirements needed for this position?
Registered Nurse with an active nursing licenses to practice in the state of the contracted Client (Arizona or Multi State Nursing License required)
Must be able to work the hours of 10 am-6:30 pm Central
Solid and stable internet connection
Minimum of 3-5 years of clinical experience
Minimum of 1-2 years of case management or care coordination experience or 2-3 years of utilization management experience
Successful work history in a clinical setting and/or health insurance environment
Bachelor’s Degree in Nursing strongly preferred
What other skills/experience would be helpful to have?
Knowledge of medical appropriateness criteria such as InterQual®, Milliman Care Guidelines®
Case Management Certification (CCM) preferred
Knowledge of CPT, ICD-10, and/or HCPC codes or coding experience
Knowledge of precertification and/or medical review processes in a health care payor or third-party environment.
Knowledge of URAC or NCQA standards
Strong critical thinking and Analytical
Strong verbal and written communication skills
Knowledge of healthcare
Medical terminology
Excellent computer literacy and beginning to moderate skills level with Microsoft Word and Excel
Strong interpersonal skills
Able to work independently
What are the working conditions and physical requirements of this job?
General office demand
Work from home office
Stable and strong internet connection
Colorado Residents Only: The base pay range for Colorado residents is $59,660 to $65,940 plus any relevant incentive pay programs that may be aligned to the role. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your base pay, Change Healthcare offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental and vision plans; wellness program; health savings account; flexible spending accounts; 401(k) retirement plan; life insurance; short-term and long-term disability insurance; Employee Assistance Program; PTO; tuition reimbursement; and employee-paid critical illness and accident insurance.
Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!
COVID Mandate
As a federal contractor, Change Healthcare is adhering to the Executive Order which mandates vaccination. As such, we are requiring all U.S. new hires and employees to show proof of being fully vaccinated for COVID-19 or receive an approved accommodation by their date of hire, as a condition of employment.
As we continue to navigate the ever-changing COVID-19 pandemic, we remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. Proof of vaccination or accommodations requests will be collected once an offer is accepted with Change Healthcare. All accommodation requests will be carefully considered but are not guaranteed to be approved.
Change Healthcare
Lake Mills Iowa
United States
Healthcare - Nursing
(No Timezone Provided)
This position is required to perform case management activities for health plan members. The activities will include assessing needs, developing a patient-centered care plan, monitoring outcomes, and coordinating interdisciplinary approaches and services. These functions may be performed onsite and/or telephonic. This position works closely with the Health Services Manager and the Medical Director to evaluate, monitor and assure coordination of services, health care coaching and navigation as it relates to condition management, quality, continuity and cost effectiveness. This position is responsible for managing utilization, gaps in care, and performing necessary interventions for positive health outcomes.
What will be my duties and responsibilities in this job?
Performs assessment, screening, and evaluation of patient’s needs.
Develops patient-centered care plans
Facilitates coordination of care for members in various levels of care to ensure appropriateness and medical necessity.
Maintains knowledge of the case management standards of practice, regulatory requirements (i.e. URAC), and state requirements for utilization and case management activities.
Initiates case planning meetings and uses an interdisciplinary process in which all members of the health care team collaborate with patients and their families to anticipate needs.
Communicates with physicians, providers, family members/care givers, and patients.
Utilizes community resources as deemed necessary and maintains on-going relationships with above.
Documents care management activities in managed care operating systems
What are the requirements needed for this position?
Registered Nurse with an active nursing licenses to practice in the state of the contracted Client (Arizona or Multi State Nursing License required)
Must be able to work the hours of 10 am-6:30 pm Central
Solid and stable internet connection
Minimum of 3-5 years of clinical experience
Minimum of 1-2 years of case management or care coordination experience or 2-3 years of utilization management experience
Successful work history in a clinical setting and/or health insurance environment
Bachelor’s Degree in Nursing strongly preferred
What other skills/experience would be helpful to have?
Knowledge of medical appropriateness criteria such as InterQual®, Milliman Care Guidelines®
Case Management Certification (CCM) preferred
Knowledge of CPT, ICD-10, and/or HCPC codes or coding experience
Knowledge of precertification and/or medical review processes in a health care payor or third-party environment.
Knowledge of URAC or NCQA standards
Strong critical thinking and Analytical
Strong verbal and written communication skills
Knowledge of healthcare
Medical terminology
Excellent computer literacy and beginning to moderate skills level with Microsoft Word and Excel
Strong interpersonal skills
Able to work independently
What are the working conditions and physical requirements of this job?
General office demand
Work from home office
Stable and strong internet connection
Colorado Residents Only: The base pay range for Colorado residents is $59,660 to $65,940 plus any relevant incentive pay programs that may be aligned to the role. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your base pay, Change Healthcare offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental and vision plans; wellness program; health savings account; flexible spending accounts; 401(k) retirement plan; life insurance; short-term and long-term disability insurance; Employee Assistance Program; PTO; tuition reimbursement; and employee-paid critical illness and accident insurance.
Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!
COVID Mandate
As a federal contractor, Change Healthcare is adhering to the Executive Order which mandates vaccination. As such, we are requiring all U.S. new hires and employees to show proof of being fully vaccinated for COVID-19 or receive an approved accommodation by their date of hire, as a condition of employment.
As we continue to navigate the ever-changing COVID-19 pandemic, we remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. Proof of vaccination or accommodations requests will be collected once an offer is accepted with Change Healthcare. All accommodation requests will be carefully considered but are not guaranteed to be approved.