Telephonic RN Complex Case Manager

Less than 5 years experience  •  Insurance

Salary depends on experience
Posted on 09/21/17
Las Vegas, NV
Less than 5 years experience
Salary depends on experience
Posted on 09/21/17

Primary Responsibilities:

  • Making outbound calls to assess members' current health status
  • Utilizing Milliman criteria to determine if patients are in the correct hospital setting
  • Coordination of member's care through the health care continuum
  • Collaborate with member, provider, facility to obtain best outcome
  • Collaborate with internal members of the health care team, to include PCP, FHS, COC and Medical Director
  • Complete cost - benefit analysis as appropriate
  • Identifying gaps or barriers in treatment plans
  • Review cases with Medical Directors daily on challenging cases as needed
  • Making referrals to outside sources
  • Documenting and tracking findings


To be considered for this position, applicants need to meet the qualifications listed in this posting.

Required Qualifications:

  • Current, unrestricted RN licensure in the state of Nevada
  • 3+ years of Clinical RN acute experience, resulting in excellent clinical skills and judgment
  • 2+ years of experience in case management in a managed care environment and / or utilization review experience in an acute/sub-acute setting
  • Strong knowledge of CMS and other regulatory agencies
  • Basic level of experience with Microsoft Word, with the ability to navigate a Windows environment
  • Strong assessment skills

Preferred Qualifications:

  • Bachelor's degree in Nursing
  • CCM
  • Coaching and / or decision support experience
  • Strong inbound and outbound telephonic skills, or ability to quickly learn


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