Provide clinically-based case management to support the delivery of effective and efficient patient care by integrating utilization management, care coordination, and transition planning functions. Manages a designated case load and plans effectively in order to meet patients needs, manage the length of stay, and promote efficient utilization of resources. Supports the physician in facilitating patient care with the objective of enhancing the quality of patient outcomes and patient satisfaction.
The UM Nurse Specialist conducts clinical reviews to ensure that services provided to members meet clinical criteria and are delivered in appropriate settings, coordinating all aspects of utilization and benefit management. They validate medical documentation, consult with medical directors, and identify members for case management, also conducting retrospective medical claims audits.
The Clinical Service Manager plays a key role in managing and supporting clinical operations and administrative functions within the Nursing Management Team. This role is crucial for improving nursing retention, ensuring the delivery of high-quality clinical care, and maintaining regulatory compliance across all nursing services. The Clinical Service Manager works closely with project management and the global clinical team to streamline clinical processes and enhance operational efficiency.
This position involves conducting face-to-face assessments of members who may need skilled nurse assessment services, completing assessments using a skilled care acuity tool, and providing service recommendations based on members' health care needs. The incumbent may also serve as a mentor for new staff, complete quality assurance audits, and participate in process improvement initiatives.
The Registered Nurse, Care Line, is responsible for providing telephonic triage directional patient care advice for general and specific illnesses, health related issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, provides remote clinical advice and Emergency Triage assessments within license and given technology.
The Practice Leader (PL) for the Neonatal Critical Care, is a Registered Nurse (RN) responsible for upholding excellence in the provision of nursing care through the implementation of professional scope and standards, organizational vision, mission and values, and strategic and operational priorities. Focus is understanding organizational goals and designing, implementing, and evaluating practice change initiatives that advance these goals.
Spectrum Healthcare Resources has a potential need for Registered Nurse Disease Managers. These will be completely remote positions, working entirely from the Nurse’s home. The Nurse will be performing assessments, education and training to coordinate care for the dependents of our Nation’s Active Duty and eligible retirees.
Responsible for ensuring superior customer experience supporting a first in class launch of AMTAGVI, an innovative cell therapy for metastatic melanoma. Oversees regional implementation of community-based education initiatives, patient navigation optimization, and metrics to drive awareness and access for AMTAGVI. Helps with early patient identification, appropriate referrals, and patient readiness for advanced therapies, such as TIL.