Travel Nurse RN - Case Manager - $40 to $44 per hour in Arlington, VA

Registered Nurse (RN) | Case Manager
Location: Arlington, VA
Agency: Conflux Systems Inc
Pay: $40 to $44 per hour
Shift Information: Days - 5 days x 8 hours
Contract Duration: 3 Months
Start Date: ASAP

About the Position

Preferred locations: Arlington, Falls Church, Annandale, or Vienna, Virginia.
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Telephonic and Field work. Candidates will need a quiet, dedicated work space with no distractions. Must have an active and unrestricted RN license in the state of Virginia or compact license.

Description The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits. Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Requirements

Experience:
-3 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
-Experience preferred managing chronic conditions, such as diabetes, hypertension, and asthma.
-Healthcare and/or managed care industry experience required.
-Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
-Effective communication skills, both verbal and written.
-Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
-Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
-Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
-Typical office working environment with productivity and quality expectations.

Assessment of Members:
• Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
• Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.

Enhancement of Medical Appropriateness and Quality of Care:
• Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
• Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes
• Identifies and escalates quality of care issues through established channels
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making
• Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

Monitoring, Evaluation and Documentation of Care:
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Majority of time is spent on telephonic outreach and documentation in a clinical case management platform.

Education RN with current unrestricted Virginia state or compact licensure.
Case Management Certification CCM preferred  #5841