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Form of workJob Description
A Medical RN Care Manager II is needed to meet HBR targets and member enrollment. Fully remote M-F 8AM - 5PM. MUST reside in the state of Indiana.
- Cold call outreach to members,
- Completion of member multiple enrollment and follow-up assessments,
- Creation of member care plans
- Input documentation into multiple computer systems
- Daily collaboration with CM/UM/Pharmacy peers to meet member needs
- Checking eligibility in FSSA system,
- Research claim encounter and Hospital systems to obtain member health history
- Maintain Case Load 50
- Daily outreach 20-40 calls daily
- Monthly Quality Audit score 90%
Education/Experience:
Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
Licenses/Certifications: Current state’s RN license.
Professional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations.
