What are the responsibilities and job description for the RN-Case Manager position at Decypher?
ecypher is a leading integrator of professional, technology, and management solutions and services. We provide our services globally to Federal, Commercial, Local and State clients. Our employees are our most valuable asset and play an integral role in the success of Decypher and our clients. Working at Decypher is not a job, but a career where your talent and energy is respected, and you can personally make a difference. Decypher invites you to join our professional team. Decypher is an equal opportunity/affirmative action employer committed to diversifying its workforce (M/F/D/V).
DESCRIPTION
Decypher is seeking a Registered Nurse Case Manager
RESPONSIBILITIES
- Develops and implements a comprehensive Utilization Management plan/program
- Performs data/metrics collection on identified program areas; analyzes and trends results, including over- and underutilization of healthcare resources
- Analyzes medical referrals/appointments and general hospital procedures and regulations by monitoring specialty care referrals for appropriateness, covered benefits, and authorized surgery/medical procedures, laboratory, radiology and pharmacy
- Reviews previous and present medical care practices for patterns; trends incidents of under-or over-utilization of resources incidental to providing medical care
- Acts as referral approval authority for designated referrals per local/AF/DoD/national guidance and standards.
QUALIFICATIONS
- Bachelors Degree (BSN)
- Registered Nurse License
- 3 years of direct patient care in a clinical setting
- 2 years of consecutive utilization management, utilization review or case management experience
- Basic Life Support (BLS)
- Advanced Cardiovascular Life Support (ACLS)
- US Citizen
- NACI background check
