RN Case Manager

Company: Quartz
Location: Madison
Posted on: January 9, 2021

Job Description:

Overview:Are you a licensed RN who is interested in using your clinical expertise outside of a clinical or hospital setting? Do you pride yourself in examining all the details of a situation before making important decisions? Are you passionate about ensuring that all patients receive optimal types and levels of care?If so, please consider joining Quartz as a Registered Nurse (RN) Case Manager. This role is responsible for conducting clinical review of authorization requests to identify and determine appropriate types and levels of patient care. This role also facilitates referrals between health plan members, participants, primary care physicians and other health care providers.Benefits:

• First shift with regular, full-time hours and no weekends or holidays.
• Supportive and experienced team members to assist with training and complex cases
• Opportunity to exercise clinical judgement and serve as a trusted Subject Matter Expert to positively impact the care and lives of Quartz patientsResponsibilities:
  • Utilize clinical judgment and knowledge of established standards to make coverage determinations based in individual member circumstances
  • Conduct prospective, concurrent, and retrospective medical reviews for coverage determinations of managed care members
  • Review medical records, conduct telephone assessments, and patient/nurse/physician interviews, and provide referrals to appropriate agencies, as needed
  • Investigate and facilitate all alternatives to services requested when specific requests cannot be authorized
  • Analyze data for case selection process utilizing resources such as claims, hospital discharge, pharmacy, and utilization management data as well as data supplied by other resources such as purchasers, member or caregiver, and practitioners
  • Care Management - establish objectives, goals and actions designed to meet patient's needs and monitor the care plan to ensure effectiveness and appropriateness of services; practice conflict resolution strategies, as needed
  • Obtain accurate and detailed clinical information from appropriate sources to facilitate clinical review of cases; maintain information for reporting purposes
  • Maintain confidentiality and adhere to the professional standards and ethics of the healthcare field and managed care industry
  • Serve as the medical liaison between contracting staff and case managers, interpreting contractual language to determine payment issues and collaborating with all parties to resolve contract issues based on medical appropriateness, as needed.Qualifications:
    • Bachelor's Degree in nursing or related field (will consider Associate's Degree with experience)
    • State of Wisconsin RN license
    • 2-3 years of RN case management experience in a clinical and/or inpatient setting
    • Valid Driver's license with the ability to travel, as necessary, within the designated service areaAdditionally, we are seeking individuals with the following skills:
      • State of Illinois and/or Minnesota RN license is preferred, or ability to obtain upon hire
      • Working knowledge of managed care as it relates to contracting in health insurance, per diems, DRG's CPT and ICD-9 coding
      • Exceptional customer service skills, including understanding the needs of culturally diverse populations, and ability to evaluate for literacy and literacy needs
      • Strong written and verbal communication skills interacting with individuals internally and externally
      • Strong independent, critical thinking skills to understand individual and operational problems and identifying appropriate solution(s)This full-time position will start working remotely due to the COVID-19 pandemic. As the pandemic situation improves, the position has the option to transition to work from one of our offices located in Madison, WI, Onalaska, WI, or Sauk City, WI or continue working remotely. Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.Quartz offers an excellent benefit and compensation package, opportunity for career advancement and a professional culture built upon the foundations of Respect, Responsibility & Relationships.Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

Keywords: Quartz, Madison , RN Case Manager, Healthcare , Madison, Wisconsin