Job Posting for RN - Case Management at Detego Health
Review planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria - prospective, concurrent and retrospective review.
Coordinate peer to peer reviews between providers and medical directors in determining coverage of requested services.
Provide intervention and coordination to decrease delays and denials.
Direct the delivery of care to the most appropriate setting, while maintaining quality
Refer members with costly medications or non-covered medications to ScriptAide for assistance via the Patient Assistance Program or the Prescription Importation Program.
Effectively manage a caseload of members with critical diagnoses and/or chronic diseases.
Develop individual care plans by conditions identified via health record assessment, patient assessment and interactions with the member’s provider(s).
Monitor and evaluate effectiveness of the care management plan and modify as necessary based on members’ progress, changes in condition and to minimize unnecessary utilizations, admissions, and readmissions.
Collaborate with the members and their physicians for seamless coordination of care and services.
Provide appropriate documentation of interactions with members, providers, and plans.
Collaborate with the Medical Director on review of procedures/medications that do not meet medical necessity review per clinical guidelines.
Conducts outbound calls to assigned case managed members to provide education on diagnosis, care plan goals and interventions, steps to minimize progression and to provide overall support to the member.
Provide procedure and/or medication cost estimates to the member’s plan.
Salary.com Estimation for RN - Case Management in Omaha, NE
$53,353 to $70,347
If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution.
Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right.
Surveys & Data Sets
Sign up to receive alerts about other jobs with skills like those required for the RN - Case Management.
Click the checkbox next to the jobs that you are interested in.