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RN Case Manager
GuideWell SourceRN Case Manager at WebTPA, managing treatment plans and healthcare goals for patients. Collaborating with interdisciplinary teams and providers to ensure effective care delivery.
About the role
Key responsibilities & impact- Case Management process includes assessing the member’s health status and care coordination needs.
- Contact with patient, family, physicians, additional health care providers, and community resources.
- Identification of alternative treatment plans, which would have to be approved by all parties.
- Assessment of the clinical status and resultant sequela to coordinate the most appropriate service to meet the individual’s health care needs.
- Identification of services, resources, providers, and facilities that could best serve members in a timely and cost-effective manner.
- Development and implementation of Case Management goals, both short and long term, with documented care plans.
- Utilize technology/resources to evaluate the cost-effectiveness of the elected treatment plan.
- Accurate and timely reporting as deemed appropriate by each client member.
- Medical record review to determine medical necessity of requested services.
- Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions.
Requirements
What you’ll need- 5+ years related work experience with a professional background in clinical nursing and patient assessment.
- Related Bachelor’s degree or additional related equivalent work experience
- Graduate of an accredited school of nursing
- RN - Registered Nurse - State Licensure
- Compact State Licensure in good standing.
- Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices.
- Ability to collaborate with cross-operational areas within the organization.
Benefits
Comp & perks- Medical, dental, vision, life and global travel health insurance
- Income protection benefits: life insurance, Short- and long-term disability programs
- Leave programs to support personal circumstances
- Retirement Savings Plan includes employer contribution and employer match
- Paid time off, volunteer time off, and 11 holidays
- Additional voluntary benefits available and a comprehensive wellness program
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
case managementpatient assessmentcare coordinationmedical record reviewtreatment plan developmentcost-effectiveness evaluationhealth care service deliverymedical necessity determinationdocumentation of care planshealth plan interpretation
Soft Skills
collaborationcommunicationorganizational skillsinterpersonal skillsproblem-solvingcritical thinkingattention to detailtimelinessadaptabilityteamwork
Certifications
Registered Nurse (RN)Compact State Licensure