Develop and implement market business plans to motivate providers to engage in improving Risk Adjustment metrics Provide analytical interpretation of Risk Adjustment reporting including, Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groups Subject Matter Expert (SME) for all Risk Adjustment related activities within their assigned market(s) working within a matrix relationship which includes DataRAP operations and Regional/Market operations Assist in developing of training and analytical materials for Risk Adjustment Oversee DataRAP training …
RN Clinical Coding Nurse Consultant WellMed San Antonio Texas
RN Case Manager Long Term Care
Assist the provider / team with various care coordination activities in the nursing home Assist the provider / team with benefit determination associated with Medicare part A, part B, and part D benefits Collaborating with the primary Advanced Practice Clinician, (APC) and nursing facility to identify and respond to patient Change in Condition May assist the provider by completing Decision Support Tool, (DST), re – assessing the patient, and other activities as delegated by the provider or the Clinical Services …
RN Case Manager – Mcdowell County, NC
Visit members in their homes to assess their current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self-management Make referrals to outside sources Provide a complete continuum of quality care through close communication with members via in-person in home or on-phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels
RN Care Manager PCT, The Everett Clinic
Care Management activities include early identification of high-risk patients, concerted planning involving physicians and mid-level practitioners, monitoring of services provided by outside physicians, home health, DME, and other providers; monitoring emergency department use as well as identifying opportunities to decrease emergency department utilization and other elements of care utilization Provides effective care management across the care continuum, including coordination involving internal and external providers of care, families and other entities, as appropriate Works in collaboration with colleagues in multiple care …
RN Care Manager PCT, Seattle – The Polyclinic
Care Management activities include early identification of high-risk patients, concerted planning involving physicians and mid-level practitioners, monitoring of services provided by outside physicians, home health, DME, and other providers; monitoring emergency department use as well as identifying opportunities to decrease emergency department utilization and other elements of care utilization Provides effective care management across the care continuum, including coordination involving internal and external providers of care, families and other entities, as appropriate Works in collaboration with colleagues in multiple care …
RN Care Manager – Thibodaux, LA Market
Discharge Planning: Works with facility Case Manager or Social Worker to coordinate DC process and transition needs based on patient’s diagnoses and status Care Coordination and Patient Support: Collaboration with the entire clinic team to proactively manage high risk patients by ensuring appropriate: Telephonic Post Hospital Discharge Calls Medication Management to include medication reconciliation post discharge and medication adherence Chronic disease education Providing self-management support to patients in order to improve their health outcomes Clinic Team Communication: Monthly meetings (in-person …
RN Care Manager – Field Based in Cumberland, Hoke, Scotland County – NC – No weekends or on-call
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Assess, plan and implement care management interventions that are individualized for each member and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for both healthcare and community based services; including but not limited to financial, psychosocial, community and state supportive services Develop and implement care plan interventions throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are …
RN Care Coordinator – Nursing Facilities – Hood/Wise County, TX
Assess, plan, and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for member transition to community request and provide assist with social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakeholders for the required health-related information to ensure quality coordinated care and services are provided …
RN Call Center Nurse – Remote
Consistently exhibits behavior and communication skills demonstrating Optum’s commitment to superior customer service, including quality, care, and concern with every internal and external customer Performs comprehensive telephonic patient assessment, evaluation, and advice while meeting production standards Follows established clinical protocols/guidelines and provides appropriate patient instructions Directs patient to appropriate levels of care based on assessment within Optum’s guidelines Documents authorizations for vendors and/or outside services as appropriate Instructs patients on procedural preparations Documents and maintains records of telephonic interactions Completes …