Ambulatory Nurse Case Manager, Registered Nurse

RCM Health Care Services

Silver Spring, MD

Posted: 5 days ago
Full-Time
Benefits: dental, life insurance, medical, vision, 401k,

Job Description

Nurse Case Managers needed for Pediatric Medical Centers in Washington DC
4 days a week 10 hour shift - every other weekend!!
TRAINING AVAILABLE: Multiple Roles Open for RNs with strong Clinical Experience looking for Pediatric Case Management as well a Nurse Case Managers with Adult or Geriatric Clinical Experience open to Pediatrics. Up to Six Figure Salaries based on experience!
FULL TIME, Permanent Roles working On-Site in Washington DC

Excellent Salaries based on RN experience and credentials ( $95,000 to $120,000 )

This role will consider a RN, BSN with 2+ year of solid clinical experience that is interested in pediatric case management. All roles will consider RNs with solid case management in managed care, acute care, ambulatory care, or home care. Pediatric experience not required if open to working with pediatrics.
Facilitates Efficient & Effective Utilization of Resources for Patients

Conduct timely clinical reviews drawing upon appropriate resources and apply nationally recognized criteria to support medical necessity of patient observation admission or inpatient admission and continued hospitalization.
Address treatment delay, potential and actual denials with the Attending physician and other relevant members of the healthcare team.

Coordinates Authorization for Reimbursement

Provide clinical reviews to third party payers and validates authorization or denial of services from them.
Document approved and denied services in STAR to facilitate meaningful data analysis.

Communicates Effectively

Communicate verbally and/or written e.g., email) with payers and healthcare team in a clear, timely, accurate and professional manner and/or organized in a professional format.

Safety

Speak up when team members appear to exhibit unsafe behavior or performance
Continuously validate and verify information needed for decision making or documentation
Stop in the face of uncertainty and takes time to resolve the situation
Demonstrate accurate, clear and timely verbal and written communication
Actively promote safety for patients, families, visitors and co-workers

Professional Practice/Research

Participate in Shared Leadership.
Ensure that nursing practice is based on evidence of best practice.
Accountable for participating in the Nursing Division's Performance Improvement process.
Participate in community activities.

Requirements
Education

Education Level - Bachelor's Degree Required

Experience

1 to 3 + years in clinical nursing required
1 year experience in Utilization Management and/or Case Management with knowledge of utilization review criteria and/or case management preferred

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Company Description

RCM Health Care Services’ mission is to provide opportunities for qualified candidates across medical professions. We deliver timely results and have built a reputation of trust with our clients and candidates. Since 1975, we have been providing staffing solutions to many of the finest healthcare institutions across the nation and careers for thousands of candidates. As professional career opportunity matchmakers, we follow up and follow through to help our clients and candidates to reach their career and life goals. We proudly hold the Joint Commission Gold Seal of Approval as well.