Care Manager RN - SOUTH (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 appropriate resources and programs to achieve optimal quality and financial outcomes.

In Short

• Identify and connect high-risk members to resources.
• Manage and triage self-referrals.
• Audit patient charts for accreditation standards.
• Assist members in understanding medical benefits.
• Evaluate Health Risk Assessment (HRA) data.
• Participate in care management program implementation.
• Review medical records for quality care assurance.
• Investigate quality of care issues.
• Work in a standard office environment.
• Role is remote but requires residence in Southern WV.

Requirements

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

Benefits

• Work with a leading healthcare provider.
• Opportunity for professional growth.
• Supportive work environment.
• Engagement in community health improvement.
• Flexible work arrangements.