RN Case Manager

$89,065 - $162,801 / year

About this Job: General Summary of Position RN Maternal Health Case Manager coordinates, negotiates, procures, and manages care of our members/enrollees to facilitate cost-effective care and members/enrollees satisfaction. Facilitates the continuum of care and works collaboratively with OB/Women's health interdisciplinary staff internal and external to the organization. Responsible for carrying a complex case management caseload, ownership of a case management program(s), pre-authorization reviews to provide Medically Necessary, timely, and quality health care services in the most cost-effective manner and pharmacy reviews per population served.We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels. Primary Duties and Responsibilities Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations. Actively develops and manages complex case management cases and develops individualized plans of care according to NCQA standards/ guidelines and the District of Columbia Contract. Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care. Acts as an advocate while assisting members/enrollees to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy. Assists hospital case management staff with discharge planning if applicable. Makes recommendation to alternate tier of Case Management programs or level of care as acuity necessitate. Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups District/ community agencies meetings etc. as assigned. Provides input completes assignments and shares new findings with other staff. Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations. Provides face to face case management in the community as the member/enrollee's health necessitate. Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy. Demonstrates skill and flexibility in providing coverage for other staff. For assigned Case Management program(s) develops strategies assessment(s) and evaluation/goal tools according to NCQA standards/ guidelines and District of Columbia Contract for the population served. Utilizes standards/ guidelines to manage and document interactions for the program (s). Responsible for verifying that assigned program utilizes up-to-date standards in the medical and behavioral health community for the population served. Keeps informed about disease processes treatment modalities and resources. Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel. Identifies inpatients requiring additional services and initiates care with appropriate practitioners. Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services. Maintains timely and accurate documentation in the clinical software system per Clinical Operation department's policy. Monitors utilization of all services for fraud waste and abuse. Performs telephonic ACD line coverage for Clinical Operations' needs. Enters authorization as appropriate to the program and sends the reviews to Medical Director as appropriate. Coordinates review decisions and notifications per policy NCQA standards/ guidelines and District of Columbia Contract for timely decision making. Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multi-disciplinary quality and service improvement teams. Minimal Qualifications Education Graduate of an accredited School of Nursing required and Bachelor's degree preferred Experience 1-2 years Case management experience required and 1-2 years UM or related experience required and 3-4 years Diverse clinical experience required Maternal Health case management preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia and/or the State of Maryland based on work location(s) Upon Hire required and CCM - Certified Case Manager Upon Hire preferred Knowledge Skills and Abilities Verbal and written communication skills. Ability to use computer to enter and retrieve data. Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred. This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

Medical-Surgical Emergency Team (MSET) RN- FT Day Shift

Mary Washington Healthcare Stafford, VA

$42.62 - $56.56 / hour

Start the day excited to make a difference…end the day knowing you did. Come join our team. Job Summary: The Medical-Surgical Emergency Team (MSET) RN will support and maintain hospital clinical operations and patient care activities in collaboration with Nursing leadership and ancillary departments. Responsibilities include ensuring quality, cost effective, timely patient care and patient experience; maintaining open channels of communication with all departments and medical staff; supporting fiscal management by ensuring effective and efficient use of human resources; mentoring and coaching staff as necessary to assist in their decision-making process; and providing feedback to respective managers. Essential Functions & Responsibilities: Supports and coordinates the Medical-Surgical Emergency Team (MSET) function within Mary Washington Healthcare. Coaches and mentors staff as they plan and coordinate patient care. Acts as a resource for nursing and medical staff. Responds to changes in patient clinical presentation and emergency situations (MSET calls and "Code Blue") and assists the patient and staff accordingly. Identifies patient care improvement opportunities, suggests plans of action, and assists with implementation and monitoring. Utilizes best practices for early identification of patients at risk for decline. Facilitates interdisciplinary team approach to improve patient outcomes. Develops collaborative relationships with physicians, unit leadership and staff to identify/implement opportunities to improve patient care services. Maintains open channels of communication and collaboration with personnel at all levels of the organization. Supports quality patient care and staff satisfaction. Provides timely feedback regarding patient and nursing concerns. Provides feedback to managers and staff regarding patient care (MSET) issues. Collaborates with Nursing leadership and educators to develop educational opportunities for the MSET Program goals, implement strategic objectives and evaluate program goals. Analyzes and performs root cause analysis of quality of care or adverse event cases. Develops and implements system changes to address identified quality of care opportunities. Trends, analyzes, and interprets organizational data related to clinical quality measures. Participates in meetings and other care initiatives to support the organization’s quality and patient safety goals. Monitors and reports performance and outcome data at appropriate meetings. Serves as a resource for issues concerning the organization’s quality goals and performance improvement initiatives. Supports patient safety program in collaboration with the Quality and Patient Safety Department, Regulatory Affairs, Risk Management and Medical Staff Services. Performs other duties as assigned. Qualifications $42.62-$54.24: Graduate of an accredited nursing program required. BSN is preferred. Valid RN License from Virginia or reciprocal compact state required. AHA BLS Provider CPR required at hiire AHA ACLS required at hire NIHSS (Bluecloud) required within 90 days Minimum of two years Supervisory/Charge Nurse experience required. Minimum of three years of clinical RN experience in an Intensive Care Unit or Emergency Department required. Experience with Microsoft Word, Power Point, and Excel required. Certification in applicable field, i.e., CEN, CCRN, etc. preferred. Qualifications $44.44-$56.56: Graduate of an accredited nursing program required. BSN is preferred. Valid RN License from Virginia or reciprocal compact state required. AHA BLS Provider CPR required at hiire AHA ACLS required at hire NIHSS (Bluecloud) required within 90 days Minimum of two years Supervisory/Charge Nurse experience required. Minimum of three years of clinical RN experience in an Intensive Care Unit or Emergency Department required. Experience with Microsoft Word, Power Point, and Excel required. Certification in applicable field, i.e., CEN, CCRN, etc. preferred. For those hired into the External Temporary RN Program: If job profile requires BLS, ACLS, PALS or NRP within any period of time, it is required at hire for an External Temporary RN. If job profile requires CPI, ONS or NIHSS within any period of time, it is required within 30 days for an External Temporary RN If job profile requires TNCC or ENPC within any period of time, it is required within 30 days or by the next available course for an External Temporary RN. MWHC will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status (EOE). We are also committed to equitable and transparent compensation practices and comply with all applicable pay transparency and pay equity laws. ‎ Required Physical Requirements: Constant (67-100% of workday) walking, standing, use of arms and hands; frequent (34-66% of workday) bending, stooping, kneeling, and squatting; ability to lift 35 lbs.; ability to push and pull 20 lbs.; auditory and visual skills to include color determination; ability to work in confined spaces; ability to reach above/overhead. Mental Requirements: Possesses critical thinking and analytical skills. Ability to multi-task. Ability to communicate effectively and collaborate with a multi-disciplinary team. Capacity to cope with difficult situations. Ability to tolerate irregular hours including evenings, nights, and weekends. Environmental Requirements and Exposure Hazards: Potential risk of exposure to radiation and toxic chemicals. Potential for exposure to bloodborne pathogens; must be able to wear appropriate personal protective equipment. “It is the policy of Mary Washington Healthcare to provide reasonable accommodations to qualified individuals with a disability who are applicants for employment or Associates.” ‎ Compensation Pay Range: $42.62 - $56.56

Registered Nurse (RN)-Occupational Health

Spectrum Healthcare Resources Southwest Washington, DC

Job Description Spectrum Healthcare Resources has an excellent opportunity for a Part-time Registered Nurse at the Federal Occupational Health Clinic (A94) in Washington, D.C. Position Highlights: Government contractor position Emphasis on work-life balance | low stress environment focusing on employee health Monday-Thursday : 8 hour shifts (32 hours/week) No evenings, weekends, holidays, or on-call responsibilities Care for federal employees in government agency buildings Requirements: 2 years of experience providing direct patient care in an acute care setting required Graduate from a National League of Nursing accredited school (Diploma, AD, or BSN) Basic Life Support Certification RN license in DC, VA or MD accepted For More Information Contact: Lauren Larkin 571-410-2088 Lauren_larkin@spectrumhealth.com Company Overview: At Spectrum, we utilize over thirty-five years of experience providing optimal solutions for federal agencies that are both innovative and cost-effective. We hold ourselves to the highest standard to ensure successful outcomes for the facilities and healthcare professionals we serve. As a Joint Commission Certified Healthcare Resource, dependability and service are the driving forces of our mission. EOE/Disabled/Veterans Location : Location US-DC-Washington DC Recruiter : Full Name: First Last Lauren Larkin Direct phone number 571-410-2088 Recruiter : Email Lauren_Larkin@spectrumhealth.com

RN

Home Health

1 month ago

Home Health RN - Sign On Bonus

LHC Group Leonardtown, MD

a { text-decoration: none; color: #464feb; } tr th, tr td { border: 1px solid #e6e6e6; } tr th { background-color: #f5f5f5; } Now Offering a $10,000 sign-on bonus available for qualified external hires. Enjoy a flexible full-time weekday schedule along with comprehensive benefits designed to support your health, well-being, and work-life balance. Service Area: St. Mary's County and Lower Calvert County Explore opportunities with HomeCall, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources. Primary Responsibilities: Clinical Competence Initiates, develops, implements, and revises the plan of care in collaboration with the physician and other health care professionals Supervises care provided by home health aides and licensed practical/vocational nurses, provides instruction, and assigns tasks according to State and federal regulations Provides required supervisory visits Documentation and Care Delivery Provides high-quality clinical services within the scope of practice and infection control standards, in accordance with the plan of care, and in coordination with other health care team members Completes comprehensive assessments (OASIS) including medication reconciliation accurately and timely Documents patient visits per policy and payer requirements, and syncs timely per LHC policy Quality Makes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentation Communicates relevant information timely and effectively with appropriate agency staff, including patient care issues, visit assignments, schedule changes, orders, OASIS data sets, coding requests, and coordination with other clinicians Communicates timely and effectively with physicians, patients, and family members to ensure quality care and service excellence Teamwork Takes direction from Clinical Director and Executive Director professionally and completes assigned tasks timely, including required learning Assists in the orientation of new agency personnel and serves as a preceptor to other staff and students Actively participates in survey/survey readiness activities and performance improvement plans, works to reduce unnecessary patient hospitalizations, improve patient safety, and implements processes and best practices to ensure positive patient outcomes Participates in on-call and weekend rotation as needed to meet patient needs Adheres to and participates in the agency's utilization management model You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. #LHCjobs Required Qualifications: Current and unrestricted RN licensure in state of practice Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation Current CPR Certification Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client Preferred Qualifications: Ability to work independently Solid communication, writing, and organizational skills Pay Range $82,995- $124.492 annual total cash target pay $47.88 - $71.82 per visit point $39.90 - $59.85 hourly rate Annual total cash compensation for this role assumes full-time employment (40 weekly hours) at full productivity and generally follows the range above. Total cash compensation includes earnings from per visit point pay and hourly pay and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. This role receives two types of compensation depending on the work being performed. When conducting visits, you will be paid per visit point rate compensation. Your per visit pay will be calculated by multiplying your per visit point rate by the productivity points you accrue for various types of visits. Each type of visit is assigned a certain number of productivity points that is inclusive of 'direct' and 'indirect' patient care activities. Visits are assigned based on patient and business needs. The number of visits performed each week will vary based on individual productivity targets and the productivity points assigned to the visits performed. You will be paid your hourly rate for certain non-visit activities such as orientation. We comply with all minimum wage laws as applicable. In addition to your pay, we offer benefits such as, a comprehensive benefits package, recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

RN

Home Health

1 month ago

Home Health RN - Sign On Bonus

UnitedHealthcare Leonardtown, MD

a { text-decoration: none; color: #464feb; } tr th, tr td { border: 1px solid #e6e6e6; } tr th { background-color: #f5f5f5; } Now Offering a $10,000 sign-on bonus available for qualified external hires. Enjoy a flexible full-time weekday schedule along with comprehensive benefits designed to support your health, well-being, and work-life balance. Service Area: St. Mary's County and Lower Calvert County Explore opportunities with HomeCall, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources. Primary Responsibilities: Clinical Competence Initiates, develops, implements, and revises the plan of care in collaboration with the physician and other health care professionals Supervises care provided by home health aides and licensed practical/vocational nurses, provides instruction, and assigns tasks according to State and federal regulations Provides required supervisory visits Documentation and Care Delivery Provides high-quality clinical services within the scope of practice and infection control standards, in accordance with the plan of care, and in coordination with other health care team members Completes comprehensive assessments (OASIS) including medication reconciliation accurately and timely Documents patient visits per policy and payer requirements, and syncs timely per LHC policy Quality Makes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentation Communicates relevant information timely and effectively with appropriate agency staff, including patient care issues, visit assignments, schedule changes, orders, OASIS data sets, coding requests, and coordination with other clinicians Communicates timely and effectively with physicians, patients, and family members to ensure quality care and service excellence Teamwork Takes direction from Clinical Director and Executive Director professionally and completes assigned tasks timely, including required learning Assists in the orientation of new agency personnel and serves as a preceptor to other staff and students Actively participates in survey/survey readiness activities and performance improvement plans, works to reduce unnecessary patient hospitalizations, improve patient safety, and implements processes and best practices to ensure positive patient outcomes Participates in on-call and weekend rotation as needed to meet patient needs Adheres to and participates in the agency's utilization management model You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. #LHCjobs Required Qualifications: Current and unrestricted RN licensure in state of practice Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation Current CPR Certification Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client Preferred Qualifications: Ability to work independently Solid communication, writing, and organizational skills Pay Range $82,995- $124.492 annual total cash target pay $47.88 - $71.82 per visit point $39.90 - $59.85 hourly rate Annual total cash compensation for this role assumes full-time employment (40 weekly hours) at full productivity and generally follows the range above. Total cash compensation includes earnings from per visit point pay and hourly pay and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. This role receives two types of compensation depending on the work being performed. When conducting visits, you will be paid per visit point rate compensation. Your per visit pay will be calculated by multiplying your per visit point rate by the productivity points you accrue for various types of visits. Each type of visit is assigned a certain number of productivity points that is inclusive of 'direct' and 'indirect' patient care activities. Visits are assigned based on patient and business needs. The number of visits performed each week will vary based on individual productivity targets and the productivity points assigned to the visits performed. You will be paid your hourly rate for certain non-visit activities such as orientation. We comply with all minimum wage laws as applicable. In addition to your pay, we offer benefits such as, a comprehensive benefits package, recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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