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Remote Nurse Case Manager

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Actalent

2mo ago

  • Job
    Full-time
    Senior Level
  • Healthcare
  • Tampa
    Remote

AI generated summary

  • You need a valid RN license (NY/IL), 5 years nursing experience (acute care preferred), case management skills, telehealth experience, strong communication, and problem-solving abilities.
  • You will engage patients, perform assessments, educate on care plans, document interactions, support reauthorizations, and collaborate with healthcare teams, ensuring quality patient management and care.

Requirements

  • Health care
  • Managed care
  • Utilization management
  • Telehealth
  • Care management
  • Disease management
  • Registered Nurse license (NY or IL required)
  • 5 full years of nursing experience (1-2 years of acute nursing experience required - e.g., emergency department, intensive care unit, critical care unit, med-surg, etc.)
  • Case management/triage experience (telehealth case management a plus!)
  • Strong communication skills
  • Ability to navigate through multiple systems/screens
  • Telehealth/remote work experience
  • Discharge planning experience
  • Experience in managed care
  • Prior experience with adult and geriatric nursing strongly preferred
  • Friendly and bright personalities preferred
  • Registered Nurse with a current and unrestricted multistate license
  • Expertise in telephonic case management
  • Excellent communication, problem-solving, and decision-making skills
  • Ability to effectively manage and prioritize tasks
  • Embrace values of accountability, consistency, engagement, empowerment, respect, and outstanding service
  • Demonstrated coachability or history of learning new Electronic Medical Record systems

Responsibilities

  • Engage Post-Acute Care patients in the program and administer initial assessments, progress surveys, and discharge surveys to prevent readmissions.
  • Perform assessments that directly tie to reducing readmissions, such as educating members about their discharge instructions, ensuring a follow-up PCP appointment is in place, medication reconciliation, educating on the signs and symptoms of their condition, and referring to community resources and caregivers.
  • Work closely with the Post-Acute Care patient home health agency nurse and physicians to facilitate education and adherence to established healthcare goals and care plans.
  • Use clinical expertise to review utilization information concerning patient care and match those needs to available care options within the Post-Acute Care Program and specific plan payer guidelines.
  • Document all interactions, guidance, and interventions in applications.
  • Act as a clinical resource for Post-Acute Care Coordinators, assisting to clarify referral source directives.
  • Receive/respond to requests from unlicensed staff regarding scripted clinical questions.
  • Support ongoing reauthorization decisions for Post-Acute Care patients and issue service reauthorizations for the home care provider based on medical necessity and payer benefit guidelines.
  • Contact referral sources to advise them of referral status and relay updates to the assigned health plan case manager.
  • Participate in and contribute to ongoing quality assessment/improvement activities, ensuring the collection of data for improved analysis and preparing reports as needed.
  • Provide evening and weekend coverage as required, subject to change based on business requirements.

FAQs

Is this position fully remote?

Yes, this position is 100% work from home, and equipment will be provided.

What is the training schedule like?

The training lasts 4-6 weeks and is conducted Monday to Friday, from 8 am to 5 pm EST.

What are the expected working hours after training?

After training, the schedule includes 5 eight-hour shifts per week, which must include Friday and Monday. One weekend day (Saturday or Sunday) is also required.

Are there any restrictions on taking time off during the initial period?

Yes, no time off is allowed for the initial 90 days on contract.

What kind of experience is required for this role?

Candidates must have a registered nurse license (NY or IL required) and at least 5 years of nursing experience, including 1-2 years of acute nursing experience.

Is telehealth experience preferred for this position?

Yes, telehealth or remote work experience is preferred.

What are the essential skills needed for this job?

Essential skills include healthcare knowledge, managed care, utilization management, telehealth, care management, disease management, strong communication skills, and the ability to navigate multiple systems/screens.

Is experience with adult and geriatric nursing necessary?

Yes, prior experience with adult and geriatric nursing is strongly preferred for this position.

What values are important for candidates to embrace in this role?

Candidates should embrace values of accountability, consistency, engagement, empowerment, respect, and outstanding service.

How is the work environment structured?

The work environment is a call center setting where nurses are on an auto-dialer and must be comfortable sitting and working at a computer for 8 hours a day.

Do we offer accommodations for applicants with disabilities?

Yes, if you need a reasonable accommodation during the application or interview process due to a disability, you can email actalentaccommodation@actalentservices.com for options.

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Actalent

An Engineering and Sciences Services Company | People to Possible

Human Resources
Industry
5001-10,000
Employees

Mission & Purpose

Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent’s global footprint and flexible delivery models ensure access to specialized talent where and when you need it. We promote consultant engagement through professional development and provide experiences to ensure continuous learning. Our people are the difference. Our expertise spans capabilities in engineering including product and manufacturing, systems and software, construction management, environmental, architecture and civil; and power and utilities. We focus on sciences capabilities in laboratory sciences, healthcare, and clinical research. Actalent is an operating company of Allegis Group, the global leader in talent solutions.