Vaccines Area Business Manager
Pfizer
Care Manager, RN
Peak Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Virginia, West Virginia • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Manage and triage self-referrals, identifying high risk members through HRA
- Reporting and admissions data, auditing patient charts of delegated case management programs to meet accreditation standards
- Connect members with in-network providers and resources
- Participate in activities related to care management program build, implementation, oversight, and delegation
- Perform utilization management reviews as needed according to accepted and established criteria, as well as other clinical guidelines and policies
- Assist members in understanding their available medical benefits
- Identify barriers preventing the member from meeting maximum quality of life
- Review and Evaluate Health Risk Assessment (HRA) data to help drive development of programs and services geared toward member needs
- Review and Evaluate member outcomes data and work with other team members on performance improvement opportunities
- Utilizing NCQA standards in auditing processes of member records as part of care management oversight processes
- Investigating potential quality of care issues that may affect the quality or safety of the health of members
Requirements
- Current unencumbered licensure with the WV Board of Registered Nurse Professional Nurses, or appropriate state board where services will be provided, as a Registered Nurse professional OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
- Three (3) years of healthcare clinical experience
- Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma; Currently enrolled in a BSN program and BSN completion within three (3) years of hire
- Management of Medicare and/or Medicaid populations preferred
- Two (2) years Care Management experience
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
- Professional development
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
healthcare clinical experienceutilization management reviewsauditing patient chartsHealth Risk Assessment (HRA)performance improvementcare managementquality of care investigationaccreditation standardsclinical guidelinesmember outcomes evaluation
Soft skills
communicationproblem-solvingteam collaborationorganizational skillsmember advocacycritical thinkinginterpersonal skillsoversightdelegationbarrier identification
Certifications
Registered Nurse licensuremulti-state licensure (eNLC)Bachelor's Degree in NursingAssociate of Science in NursingDiploma in Nursing
