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Posted: Friday, November 3, 2017 3:12 AM

RN Case Manager with our large managed care provider in MOBILE, AL --- Coordinates and manages relationships with single office practices to multiple provider practices.
  • Consistently monitors participating provider performance on the identified P4Q and/or HEDIS STAR measures and regularly communicates status of those measures to the appropriate team members.
  • Establishes and maintains regularly scheduled contact with designated Point-of-Contact in each participating office and conducts on-site visits in those offices. Coordinates and ensures that all communication is maximized effectively between the practice, health plan, and any disease management vendors
  • Coordinate and manage relationships with participating provider practices. Initiate and maintain ongoing productive and positive relationships with designated Point-of-Contact in each practice.
  • Facilitate resolution of any discrepancies between claims and practice medical records.
  • Communicate pertinent care and/or clinical information to the health plan for follow-up or inclusion in Company s medical records.
  • Maintain physical presence in participating.
  • Serve as ongoing resource and support for Program needs in identified practices. Assist with communication between Point-of-Contact and practice staff/physicians.
  • Participate in all operational meetings/calls as identified between practices and the health plan. Participate in regularly scheduled Practice Coordinator team conference calls.
  • Partner with in-office Point-of-Contact to ensure practice success:
  • Review and participate in audits of medical records. Coordinate real-time performance measure management across multiple practices that provide care for members in total by utilizing the designated Company system.
  • Ensure that participating practices are driving improvement on Program performance measures.
  • Review data for those members that are frequent users of healthcare resources to ensure they are receiving the proper coding and care.
  • Suggest physician referrals to case management or behavioral health. Communicate real-time updates to identified Company team members. Develop and maintain a process to ensure that all members in participating practices receive the screenings and services needed within the given timeframe.
  • Maintain detailed understanding including clinical, coding, and operational knowledge of all Program HEDIS STAR performance measures. May assist with data collection related to proper coding and documentation.


  • Skills:
  • Registered Nurse with at least one year related experience in a healthcare environment.
  • Excellent written and oral communication skills and problem solving skills
  • Highly organized and proactive and ability to handle multiple tasks and set priorities; Detailed oriented
  • Works independently with minimum of supervision.
  • Ability to travel to and work at participating practices.
  • Ability to lift and move 35-40lbs.
  • Minimum of two years clinical practice experience in a provider


Why Kelly ?
With Kelly, you'll have direct connections to leading healthcare companies-providing you with the chance to positively impact quality and delivery of patient care. In a field where innovation and change happen constantly, our connections and opportunities will help you take your career exactly where you want to. We work with 95 of the Fortune 100 companies, and more than 1,200 healthcare hiring managers turn to us each year to access the best talent: people like you.
Let us help advance your healthcare career today.

About Kelly Services

As a workforce advocate for over 70 years, we are proud to directly employ nearly 500,000 people around the world and have a role in connecting thousands more with work through our global network of talent suppliers and partners. Revenue in 2016 was $5.3 billion. Visit kellyservices.com and connect with us on Facebook , LinkedIn and Twitter .
Kelly Services is an equal opportunity employer including, but not limited to, Minorities, Females, Individuals with Disabilities, Protected Veterans, Sexual Orientation, Gender Identity and is committed to employing a diverse workforce. Equal Employment Opportunity is The Law.


Associated topics: asn, cardiothoracic, care unit, ccu, intensive care unit, neonatal, nurse clinical, psychiatric, tcu, unit

Source: http://www.jobs2careers.com/click.php?id=4623318298.96


• Location: Mobile

• Post ID: 26028962 mobile
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