- Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
- Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
- Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
- Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan.
- Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
- Assists with development of utilization/care management policies and procedures.
- Participates in or leads intradepartmental teams, projects, and initiatives.
- Minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience and a minimum of 1 year in a Nurse Care Mgr I role or equivalent experience; or any combination of education and experience, which would provide an equivalent background.
- Current, unrestricted RN license in the state of residence required.
- Multi-state licensure will be required.
- AS or BS in nursing preferred.
- Multi-state or Compact license, or additional individual state RN licenses a plus.
- Clinical Experience in Med/Surg, Critical Care, ER, internal medicine a plus.
- Call center or telephonic environment a plus.
- Patient assessment and education preferred.
- Certification as a Case Manager is preferred.
- Prior managed care experience preferred.
- Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.
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Social Care Manager
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Neptune Enterprises Atlanta, GA, United States Freelance"Right in the middle of life", the DOMICIL Group ensures the well-being of our residents at over 45 locations with over 5,500 dedicated colleagues in Atlanta, GA. · We are a family-owned and operated company and believe that trust is built through actions, not promises. That's wh ...
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Aurora Ventures Fulton, United StatesThe GHD GesundHeits GmbH Deutschland is a nationwide healthcare company in the areas of rehabilitation, assistance, and medication. With our approximately 2,500 employees, our goal is to provide our patients and customers with high-quality products and services. We care for our p ...
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Care Manager
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Care Manager
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Spectraforce Technologies Inc Atlanta, GA, United StatesPosition: Care Manager I (RN) · Location: Remote-CA (PST, but MUST have CA licensure) · Duration: 2 Months · Education/Experience : Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of pediatric clinical nursing experience in a c ...
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2 weeks ago
Viva USA, Inc. Atlanta, United States· Title: Care Management Associate - Remote · Description: · Position Summary & Duties : · Enhancement of Medical Appropriateness and Quality of Care: · Using holistic approach consults with utilization management clinicians, hospital discharge planning staff, supervisors, a ...
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Social Care Manager
5 days ago
Trinity Health Corporation Atlanta, United StatesEmployment Type: · Full time · Shift: · Description: · Position Purpose: Mercy Care Atlanta is seeking a dynamic Manager of Social Care to lead the development, implementation, and enhancement of our Social Care programs. In this pivotal role, you will oversee wrap-around service ...
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CARES Case Manager
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Ascensa Health Atlanta, United StatesJob Description · Job DescriptionAscensa Health (formerly St. Jude's Recover Center) has been serving the Atlanta community for nearly 60 years; providing substance use and co-occurring disorder treatment to nearly 1500 individuals each year. Our staff provide clients with except ...
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Manager Respiratory Care
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Manager, Social Care
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Trinity Health Atlanta, United StatesEmployment Type: · Full timeShift: · Description: · POSITION SUMMARY: · The Manager of Social Care is responsible for the overall development, application, and implementation of Mercy Care's Social Care programs, to include wrap around services for patients, case management, ...
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Customer Care Manager
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MillerKnoll Atlanta, United StatesThe Manager of Customer Care is responsible to lead a Herman Miller Customer Care team supporting our dealer network, sales, manufacturing, distribution, procurement, for the customer service strategy and deployment for Herman Miller and Sales Operations team. Plans and directs a ...
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Manager, Social Care
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Trinity Health Atlanta, United StatesEmployment Type:Full time · Shift: · Description: · POSITION SUMMARY: · The Manager of Social Care is responsible for the overall development, application, and implementation of Mercy Care's Social Care programs, to include wrap around services for patients, case management, ...
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Care Management Educator
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Care Management Coordinator
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Care Management Specialist
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Nurse Care Manager ll - Atlanta, United States - Elevance Health
Description
Nurse Care Manager ll (2:30pm – 11am Eastern Time) JR114007
Work Hours : 2pm – 11pm Eastern Time, Monday – Friday.
Location: Must reside within 50 miles / 1 hour commute of an Elevance Health Main Office / PulsePoint. Atlanta, Georgia area strongly preferred.
The Nurse Care Manager ll is responsible for collaborating with healthcare providers and members to drive personalized health management and improve health outcomes for optimal consumers. Performs assessments and care management activities telephonically within the scope of licensure for members with complex and chronic care needs. Primary duties may include, but are not limited to:
Minimum Requirements:
Preferred Qualifications:
Nurse Care Manager ll professionals in Atlanta
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Joli Dionne
elite home care professional
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Louise Dagobert
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