LPN or RN Nurse Case Manager (Onsite at Providers Office)Philadelphia, PA

About the position

The LPN or RN Nurse Case Manager is responsible for coordinating and managing relationships with participating provider practices to ensure quality healthcare services for health plan customers. This role involves assessing patient needs, developing treatment plans, and ensuring compliance with quality metrics such as HEDIS and STAR performance measures. The Nurse Case Manager will work onsite at provider offices in Philadelphia, PA, and will utilize clinical skills to facilitate appropriate healthcare outcomes for customers.

Responsibilities
• Identifies gaps in needed quality metrics for customers and communicates to provider.
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• Maintains physical presence in participating provider practices.
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• Identifies high-risk/high-cost patients for case management intervention.
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• Interfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning, and alternative treatment plan development.
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• Identifies customer needs, coordinates and supports planned and unplanned transitions and post discharge follow up calls which may include primary care physician and specialist appointment scheduling.
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• Collaborates with the attending physician to achieve identified patient outcomes.
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• Attend and participate in weekly Complete Health Team rounds -market dependent.
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• Perform telephonic outreach.
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• Communicates with all departments to resolve issues or document trends.
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• Understands and follows administrative guidelines (policy and procedure) of the unit.
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• Attends and actively participates in staff meetings.
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• Other Duties as assigned.

Requirements
• Current Licensure as a registered nurse in the state of residence in good standing.
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• Associates degree, diploma, or B.S. in Nursing.
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• Three to Five (3-5) years recent experience in an acute-care environment, case-management, or utilization management position (experience can be a combination of LVN/RN licensure).
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• Previous HEDIS and/or CMS STARs experience a plus.

Nice-to-haves
• Bilingual - preferred Spanish both conversational and written.

Benefits
• Medical, vision, and dental insurance coverage.
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• Well-being and behavioral health programs.
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• 401(k) with company match.
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• Company paid life insurance.
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• Tuition reimbursement.
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• A minimum of 18 days of paid time off per year and paid holidays.

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