Care Manager RN - Peak Health - Remote

Overview

The Care Manager RN will be an integral member of the health plan’s medical management team, responsible for connecting high-risk members to resources and programs to achieve optimal quality and financial outcomes.

In Short

• Manage and triage member self-referrals to care management programs.
• Identify high-risk members through Health Risk Assessments (HRA).
• Audit patient charts to meet accreditation standards.
• Assist members with understanding medical benefits and connecting to providers.
• Review outcomes data for performance improvement opportunities.
• Utilize NCQA standards in auditing member records.
• Investigate potential quality of care issues.
• Participate in care management program implementation and oversight.
• Assist in policy and procedure updates.
• Work in a standard office environment.

Requirements

• Current unencumbered RN licensure.
• Three years of healthcare clinical experience.
• Bachelor's Degree in Nursing or ASN/Diploma.
• Management of Medicare/Medicaid populations preferred.
• Two years of Care Management experience preferred.
• Knowledge of InterQual and/or Milliman Care Guidelines.
• Excellent communication skills.
• Problem-solving capabilities.
• Attention to detail.
• Proficiency with Microsoft Office.

Benefits

• Opportunity to work in a leading health system.
• Engagement in improving community health status.
• Professional development opportunities.
• Supportive work environment.
• Competitive salary and benefits.