Care Management Coordinator

  • Title: Care Management Coordinator
  • Type: Full-Time/Contract
  • Location: Fort Washington, PA
  • Salary Range: $30-$33/hour
  • Post Date: 10/09/2014

Healthcare Staffing - The Protocall GroupWork in a satisfying and rewarding field as a Care Management Coordinator!  Positions are available for a full-time opportunity from October 20, 2014 until December 12, 2014 in Fort Washington, PA area. Our Care Management Coordinators are able to see the difference they make in their patient’s lives on a day to day basis!Contact us today to experience our staff’s endless commitment to enhancing your career and let us help you get the work YOU WANT!

Job Description:

The Care Management Coordinator is responsible for overseeing the appropriate and cost-effective medical care to members. The Care Management Coordinator also implements quality care standards, while limiting member’s and client’s exposure to unnecessary and inappropriate treatment. In addition, the CMC will act as a patient advocate and resource when accessing the health care system.

Position is Monday-Friday 8:30am-5:00pm 10/20/14 – 12/12/14

Responsibilities Overview:

  • Evaluate proposed plans of treatment, as defined in the precertification requirements of the group plan
  • Using the medical criteria of InterQual and/or Medical Policy, established the need for inpatient, continued stay and length of stay, procedures and ancillary services
  • Directs the delivery of care to the most appropriate setting, while maintain quality
  • Contacts attending physicians regarding treatment plans/plan of care and clarifies medical need evaluation
  • Presents cases to Medical Directors that do not meet established criteria and provides pertinent information regarding member’s medical condition and the potential home care needs
  • Performs early identification of members to evaluate discharged planning needs.
  • Collaborate with facility case management staff, physician and family to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting
  • Identifies and refers cases for case management and disease management
  • Identifies quality of care issues including delays in care
  • Appropriately refers cases to the Quality Management Department and/or Sr. Clinical Svcs Nurse when indicated
  • Maintains the integrity of the system information by timely, accurate data entry
  • Utilization decisions are compliant with state, federal and accreditation regulations
  • Ensures that all key functions are documented via Care Management and Coordination Policy
  • Works to build relations with all providers and provides exceptional customer service
  • Reports potential utilization issues or trends to designated manager or senior clinical nurse and recommendations for improvement
  • Participates in the process of education providers on managed care
  • Open to new ides and methods; creates and acts on new opportunities; is flexible and adaptable
  • Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy
  • Performs additional job-related duties as assigned

Pay: $30-$33/hour based on experience

 

Desired Candidates MUST:

  • Have an active PA or NJ Registered Nurse license
  • Have a minimum 2-5 years clinical experience (Intensive Care, Trauma, Home Health a plus)
  • Medical management/precertification experience preferred
  • Be oriented in current trends of medical practice
  • BSN preferred
  • Treat clients, team members and the public with courtesy, respect and present a positive public image

If you meet the above requirements we want to hear from you! Interested candidates please email a current resume to Michele@protocallgroup.com

The Protocall Group is an Equal Opportunity Employer.

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