the smart solution for Trenton jobs

RN Care Management Coordinator

Company: ZolonTech
Location: Trenton
Posted on: May 19, 2019

Job Description:

Contract - 3 + months Under the direction of a designated Care Management and Coordination Manager, performs telephonic/electronic reviews from providers and members for inpatient and outpatient services. Evaluates the planned procedure or treatment for medical appropriateness and setting as well as ensure application of benefit exclusion. Duties and responsibilities: Performs Clinical Precert reviews for inpatient admissions and outpatient services as well as coverage for a service or procedure. Utilizes medical policy, Care Management and Coordination policy as well as precert binder as guidelines for approvals, contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for requested setting to obtain service. Refers cases to the medical director that do not meet established criteria or medical policy guidelines Performs early identification of hospitalized members to evaluate discharge planning needs. Maintains the integrity of the system information by timely, accurate data entry. Utilization decisions are in compliance with state, federal and accreditation regulations. Ensures that all key functions are documented via Care Management and Coordination Policy. Works to build relations with all providers and provides exceptional customer service. Reports potential utilization issues or trends to designated manager or senior care coordinator and recommendations for improvement. Participates in the process of educating providers on managed care. Is comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable. Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy. Performs additional related duties as assigned Knowledge, skills and abilities required: Registered Nurse with active RN license in State of employment. BS preferred. Minimum of one year of acute care clinical experience in a hospital or other health care setting. Prior UM experience is desirable. Skills: Exceptional communication, problem solving, and interpersonal skills; focused, professionalism, action oriented with strong ability to set priorities and obtain results. Organized, demonstrates excellent team management skills Team Player. Ability to effectively utilize time management.

Keywords: ZolonTech, Trenton , RN Care Management Coordinator, Executive , Trenton, New Jersey

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Executive Jobs

Director, Communications
Description: Position Summary The Director, Communications will work closely with the VP, Marketing Community Relations to help move forward strategic communicationsinitiatives at White Plains Hospital. He/she (more...)
Company: White Plains Hospital
Location: White Plains
Posted on: 05/23/2019

Unit Manager - RN
Description: DescriptionManorCare Health Services - Lancaster is hiring for a Unit Manager ManorCare - Lancaster is a 172 bed facility with short-term rehab, long-term care, and memory-care.Employer provides a range (more...)
Company: HCR ManorCare
Location: Lancaster
Posted on: 05/23/2019

Retail Management - NJ South and Surrounding Area
Description: Job Snapshot Location:Hamilton Township, NJ Job Type:GameStop Retail Management Experience:Not Specified Date Posted:4/24/2019Job DescriptionPLEASE NOTE: Your application for this position includes (more...)
Company: Gamestop Corp.
Location: Trenton
Posted on: 05/23/2019

RN Case Manager - Emergency Department Full Time Day
Description: Coordinates quality healthcare services to meet a patient's specific healthcare needs as a result of gathering relevant and comprehensive information by
Company: Monmouth Medical Center - Southern Campus
Location: Lakewood
Posted on: 05/23/2019

National Accounts Manager
Description: br Our client, a growing Generics Pharmaceutical Company, is looking for a National Accounts Manager. br br The National Accounts
Company: Cameron Craig Group
Location: Elizabeth
Posted on: 05/23/2019

Validation Director (Design Group)
Description: Validation Director - New Jersey Minimum of 10 years' experience with increasing responsibility in validation/quality service and project management of life sciences, biotech or other FDA regulated projects. (more...)
Company: Barry-Wehmiller Group
Location: New Brunswick
Posted on: 05/23/2019

(RN) Integrated Health Team Manager Moen - Wilmington
Description: It's fun to work in a company where people truly BELIEVE in what they are doing We're committed to bringing passion and customer focus to the business. Integrated Health Team manager DESRIPTION : The (more...)
Company: Cigna
Location: Wilmington
Posted on: 05/23/2019

Dir., Project Management
Description: OverviewAs a member of the corporate team, you ll focus on enhancing the relationship with our clients as we provide outstanding business solution services. Within departments like Accounting Finance, (more...)
Company: Conduent
Location: Cherry Hill
Posted on: 05/23/2019

Configuration Management Specialist
Description: Plano 1 31061 , United States of America, Plano, TexasAt Capital One, we're building a leading information-based technology company. Still founder-led by Chairman and Chief Executive Officer Richard (more...)
Company: Capital One
Location: Wilmington
Posted on: 05/23/2019

Senior Director, External Innovation Search and Evaluation,
Description: The J J Innovation Centers, a part of Johnson
Company: Johnson & Johnson
Location: New Brunswick
Posted on: 05/23/2019

Log In or Create An Account

Get the latest New Jersey jobs by following @recnetNJ on Twitter!

Trenton RSS job feeds