RN Care Manager, Care Management, 20 Hours (Every Weekend)

Position: RN Care Manager

Department: Care Management

Schedule: 20 Hours (Every Weekend)

JOB REQUIREMENTS

EDUCATION:

Nursing degree: Diploma, ASN or BSN (preferred), Ability to obtain BSN within 4 years

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Licensed to practice as a Registered Nurse in the commonwealth of Massachusetts

CCM or related certification attained within 24 months from the hire date is preferred

EXPERIENCE:

3-5 years of diversified clinical experience is required

A minimum of 2 years of previous experience involving judgment and decision making, preferably in a utilization management/case management position

KNOWLEDGE AND SKILLS:

• Extensive background and knowledge of current medical/surgical patterns of practice.

• Medical terminology and standard medical abbreviations.

• Managed care concepts, the various health care delivery systems

• Methods for assessing an individual are level of physical/mental impairment, understanding of the physical and psychological characteristics of illness, and understanding of expected treatment.

• Confidentiality issues and the legal and ethical issues pertaining to them.

• ICD-9 and CPT nomenclature and the ability to interpret and convert this information, as applicable.

• Knowledge of benefits and various plan contracts, eligibility issues and requirements.

• Role and functional responsibilities of case management professional; case management program philosophy and purpose within Managed Care Program

• Excellent interpersonal, verbal and written communication and negotiations skills

• Strong analytical, data management and PC skills