Privia is looking for a forward thinking, organized, energetic Nurse Care Manager that delivers on objectives and seeks an opportunity to develop, implement, and deliver change within our medical group and affiliated partners. The Nurse Care Manager will provide extensive care coordination for Privia’s highest risk patients.
This position provides front line intake clinical screening to members who need skilled nurse assessment services. The incumbent is accountable for performing and documenting all member outreach activities, which may include assessing urgency of assessment referrals, determining members acuity level, current health status, and determining the type of assessment most applicable for members based on their health care needs at the time of referral.
The Care Manager collaborates with the care team within each practice and leverages Aledade’s interdisciplinary care team to provide telephone-based health coaching, quality improvement, and care coordination. The care manager works closely with Medicare patients to support them in becoming active in their health care.
As a DaVita Integrated Kidney Care Registered Nurse (RN) Case Manager, you will support complex patients, assisting them in navigating the healthcare system. You'll identify medical, social, emotional, and financial needs and implement interventions. You will work autonomously and in collaboration with the healthcare team to coordinate quality, consistent, cost-effective care supporting patients in the Central Jersey area.
Maintain and monitor your own patient census across multiple facilities. Coordinate the implementation of Chronic Care Management (CCM) services amongst chronically ill patients. Create individualized Care Plans, monitor labs, vitals, and medications, and coordinate with the care team.
Provide UM services, transition of care and support to members and health care providers. Utilize clinical knowledge and expertise to interpret and appropriately apply medical policy, medical necessity criteria (InterQual), and benefit information to provide consultation and responses to UM requests. Proactively assess and assist members to help move them through the continuum of care.
The UM Nurse Specialist conducts clinical reviews to ensure that services provided to members meet clinical criteria and are delivered in appropriate settings. They coordinate, document, and communicate all aspects of utilization and benefit management, handling both prospective and retrospective care reviews. The role involves validating medical documentation, consulting with medical directors, and identifying members who may benefit from case management services.