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Nurse RN 1

ICONMA

Role overview

Qualifications

  • Agile Experience – 2 Years minimum
  • Managed Care, specifically DSNP
  • Microsoft Application proficiency
  • Education Requirements: RN

Responsibilities

  • Research and design treatment/care plans to promote quality of care and cost-effective health care services.
  • Initiate timely individualized care plans based on health risk assessment completion and assist in transitions of care.
  • Determine appropriateness of referral for CM services, mental health, and social services.
  • Conduct member care review with medical groups for continuity of care.

Key facts

Hard skills

Other skills

  • Microsoft Software

About the company

ICONMA logo

ICONMA

Management Consulting

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company details

Company typeLarge
IndustryManagement Consulting
Company size1001 - 5000

Links

Website LinkedIn See all jobs

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Job description

Our Client, a Health Insurance company, is looking for a Nurse RN 1 for their Remote location.
 
Responsibilities:
  • Research and design treatment /care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type.
  • Initiate timely individualized care plans (ICP) based on health risk assessment (HRA) completion, participation in and documentation of interdisciplinary meetings (ICT), assisting in transitions of care across all ages.  This role will focus on the population that was unable to be reached or declined to complete a HRA.
  • Determine appropriateness of referral for CM services, mental health, and social services.
  • Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD).
  • Conduct member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental cases.
  • Manage member treatment to meet recommended length of stay. Ensure DC planning at levels of care appropriate for the members’ needs and acuity
  • Assess members’ health behaviors, cultural influences and clients belief/value system. Evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers.
  • Research opportunities for improvement in assessment methodology and actively promote continuous improvement. Anticipates potential barriers while establishing realistic goals to ensure success for the member, providers and Client.
  • Determine realistic goals and objectives and provide appropriate alternatives. Actively solicit client’s involvement. 
  • Design appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes. Adjust plans or create contingency plans as necessary.
  • Assess and re-evaluates health and progress due to the dynamic nature of the plan of care required on an ongoing basis. Initiates and implements appropriate modifications in plan of care to adapt to changes occurring over time and through various settings
  • Develop appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes.
  • Recognize need for contingency plans throughout the healthcare process.  
  • Develop and implement the plan of care based on accurate assessment of the members and current of proposed treatment
 
Requirements:
  • Agile Experience – 2 Years minimum
  • Managed Care, specifically DSNP
  • Microsoft Application proficiency
  • Excellent organization, documentation
  • Education Requirements: RN
 
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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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