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Nurse Case Manager

Description


Nurse will perform outreach calls to Medicare members that have been identified as having 'care gaps' on their Health Risk Assessment form in order to close the gaps for the member's health benefit and support the health plan in achieving and maintaining a higher Medicare 'Star Rating' as defined by The Centers for Medicare and Medicaid Services (CMS).

Roles and Responsibilities

• Conducts outreach calls to Medicare members of health plan to gather the appropriate/necessary clinical data to 'close' identified care gaps.

• Applies clinical/'soft' case management skills to close care gap and complete appropriate documentation.

• Maintains quality and productivity standards as outlined in the Service Level Agreement.

• Ensures the integrity and high quality of calls made to Medicare members of health plan.

• Adheres to accreditation, contractual and regulatory guidelines.

• Maintain the highest level of confidentiality and professionalism at all times.

• Strictly follows company policies related to the handling, release and disposal of confidential information.

• Ensures that the Operations Manager or designee is made aware of any potential risk management issues in a timely manner.

• Consistently meets medical management standards for attendance and punctuality.

• At all times treats others with dignity and respect.

Job Licensure and Qualifications
Licensure:

  • Current, active and unrestricted RN license preferred



Qualifications:


• RN License

• *Knowledge of Centers for Medicare & Medicaid Services (CMS).

• *Experience in HEDIS and Medicare guidelines.

• Intermediate Microsoft Word, Excel, Outlook skills.

• Proficient in navigating through multiple computer applications.

• Excellent communication, time management, critical thinking, and problem solving skills.
Education:

• High School Diploma or equivalent

• AS or BS preferred

Requirements

 

Job Snapshot

Location US-FL-Tampa
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Health Care
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Company Overview

Accounting Now

ACCOUNTING NOW® is one of the fastest growing financial recruitment companies in the country. We specialize in matching financial professionals with the right contract or full-time job opportunities in finance, accounting and banking. Our clients are many of the country's top financial firms and corporate departments. Accounting Now, and its full-time placement division, SNI Financial, can help you build your career! Learn More

Contact Information

US-FL-Tampa
Accounting Now
Snapshot
Accounting Now
Company:
US-FL-Tampa
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care
Store Type:

Description


Nurse will perform outreach calls to Medicare members that have been identified as having 'care gaps' on their Health Risk Assessment form in order to close the gaps for the member's health benefit and support the health plan in achieving and maintaining a higher Medicare 'Star Rating' as defined by The Centers for Medicare and Medicaid Services (CMS).

Roles and Responsibilities

• Conducts outreach calls to Medicare members of health plan to gather the appropriate/necessary clinical data to 'close' identified care gaps.

• Applies clinical/'soft' case management skills to close care gap and complete appropriate documentation.

• Maintains quality and productivity standards as outlined in the Service Level Agreement.

• Ensures the integrity and high quality of calls made to Medicare members of health plan.

• Adheres to accreditation, contractual and regulatory guidelines.

• Maintain the highest level of confidentiality and professionalism at all times.

• Strictly follows company policies related to the handling, release and disposal of confidential information.

• Ensures that the Operations Manager or designee is made aware of any potential risk management issues in a timely manner.

• Consistently meets medical management standards for attendance and punctuality.

• At all times treats others with dignity and respect.

Job Licensure and Qualifications
Licensure:

  • Current, active and unrestricted RN license preferred



Qualifications:


• RN License

• *Knowledge of Centers for Medicare & Medicaid Services (CMS).

• *Experience in HEDIS and Medicare guidelines.

• Intermediate Microsoft Word, Excel, Outlook skills.

• Proficient in navigating through multiple computer applications.

• Excellent communication, time management, critical thinking, and problem solving skills.
Education:

• High School Diploma or equivalent

• AS or BS preferred

Requirements

 
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