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Care Management Nurse

Job Attributes

Job Id:

19804

Job Category:

Clinical & Life Sciences

Job Location:

Durham, NC  27701

Security Clearance:

No Clearance

Business Unit:

Piper Companies

JOB DESCRIPTION

Piper Clinical Solutions is seeking a motivated Care Management Nurse in Durham, NC to support a Health Insurance Company with care management and coordination activities with multiple providers across all medical service lines.

 

Responsibilities for the Care Management Nurse:

  • Assist patients, affiliated family members, and health care providers to develop and coordinate treatment plans for each member claim
  • Determine the appropriate discharge and care plans for each patient by identifying specific disease process and unique family dynamics and applying to each case as needed to develop the care and discharge plans
  • Document and update all aspects of the care plan from initial assessment, development of the plan, implementation, monitoring, and evaluating outcome
  • Communicate with providers, patients and internal departments to facilitate proper care
  • Obtain patient consent for specified services
  • Analyze and report case management activity according to specific protocols for assigned cases
  • Authorize services as defined through correspondence with the medical director and refer cases that do not meet criteria
  • Ensure medical necessity and utilization review determinations meet requirements for applicable regulatory agencies
  • Potential to issue denials according to specific claims criteria
  • Negotiate and secure contractual arrangements for provision of outside providers

Qualifications for the Care Management Nurse:

  • 3+ Years of Acute Care Nursing Experience
  • Active North Carolina Registered Nursing License (RN) OR Licensed Practical Nurse (LPN)
  • Nursing Diploma, Associate’s Degree OR Bachelor’s Degree in Nursing

Compensation for the Care Management Nurse:

  • Salary up to $83,000 based on meeting of requirements
  • Benefits: Health, Dental & Vision Insurance, 401K Contributions & Life Insurance

 

Please send all qualified resumes to: idusci@pipercompanies.com

 

Keywords

Utilization review, registered nurse, milliman, interqual, ICD-9, ICE-10, CPT, HCPCS, DRG, APC, CPT, pre-pay, acute care, health insurance, health plan, health care, medical review, nurse, manager, intake, outpatient, medical review, home care, RN, CCM, Certified case manager, case management, medicare, medicaid, advance med, aerial, cms, tri care, healthsuite, advantage md, ushfp, ehp, priority partners, hospital, discharge planning, NCDOI, NCQA, Federal, care management, case management, LPN, licensed practical nurse

 

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Job Id:

19804

Job Category:

Clinical & Life Sciences

Job Location:

Durham, NC  27701

Security Clearance:

No Clearance

Business Unit:

Piper Companies