Inpatient Case Manager RN

Inpatient Case Manager RN Job Details

Category: Managed Care Nursing

Agency: Elderplan

Status: Regular Full-Time

Office: Office-based

Salary: $90,000.00 - $110,000.00 per year

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

The MJHS Difference

At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness and belonging for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization, and the fulfillment of having a lasting impact on the communities we serve.

Benefits include:

• Sign-on Bonuses OR Student Loan Assistance for clinical staff
• FREE Online RN to BSN and MSN degree programs!
• Tuition Reimbursement for all full and part-time staff
• Dependent Tuition Reimbursement for clinical staff!
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental, and vision coverage for employee and their family members
• Two retirement plans! 403(b) AND Employer-Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities:

Provide quality, cost-effective care to all members by evaluating the need for and pre-authorizing requests for inpatient, outpatient, specialty care, home care, DME, and transportation services, from network and out-of-network providers, in accordance with departmental criteria and guidelines. managed care nurse, managed care rn, nursing, rn, nurse, care management

Qualifications:

• Graduate of an accredited nursing program; Bachelor's degree preferred.
• Minimum of three (3) years of experience in medical/surgical nursing.
• Working knowledge of utilization management processes.
• Knowledge of Federal and State managed care regulations.
• Prior managed care experience preferred.
• Working knowledge of Windows, Word, and Excel.
• Licensed to practice as a registered nurse in the state with current registration.
• CCM preferred.
• Knowledge of current standards of medical practice.
• Ability to solve problems through the application of nursing theory and processes.
• Excellent written and oral communication skills.
• Knowledge of current standards of the healthcare delivery system.
• Ability to set priorities.
• Ability to work independently while recognizing issues having departmental or organizational impact Ability to work as a team member and facilitate communication among the member, healthcare providers, community and medical management staff. Elderplan in order to meet the healthcare needs of the member.