RN - Case Manager - Acute Care

Mô tả công việc

RN - Case Manager - Acute Care Registered Nurse - Case Manager - Acute Care Humana is hiring a RN Senior Case Manager in Atlanta, GA. As a Registered Nurse- Senior Case Manager will engage our members to develop lifelong wellbeing and health. The Registered Nurse- Senior Case Manager who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria. Job Responsibilities Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria Conduct admission review, post-discharge calls and discharge planning