RN Case Manager - Making a Difference in Healthcare Coordination

V-Tech Solutions, Inc. is seeking a compassionate and detail-oriented RN Case Manager to join our dedicated team supporting our client in Washington, DC. This role offers a flexible hybrid schedule with 4 days on-site and 1 day remote, providing an ideal work-life balance while making a meaningful impact on patient care.

As our RN Case Manager, you'll serve as a vital advocate for members/enrollees, ensuring they receive cost-effective, high-quality healthcare services tailored to their unique needs. You'll collaborate with interdisciplinary teams to address psychiatric and psychosocial needs while maintaining the highest standards of care and member satisfaction.

Key Responsibilities:

• Develop and manage complex case management cases with individualized care plans following NCQA standards/guidelines and District of Columbia Contract requirements
• Advocate for members/enrollees by coordinating access to medical, psychiatric, psychosocial, and other essential healthcare services
• Authorize and monitor covered services according to policy guidelines
• Collaborate with hospital staff on discharge planning and recommend appropriate levels of care based on patient acuity
• Provide face-to-face case management in community settings when required by member/enrollee health needs
• Demonstrate flexibility in providing coverage for team members
• Develop strategies, assessments, and evaluation tools for assigned Case Management programs
• Stay informed about current disease processes, treatment modalities, and community resources
• Identify and report potential coordination of benefits, third-party liability, and other insurance matters
• Recognize patients requiring additional services and initiate appropriate care coordination
• Maintain current knowledge of benefits and enrollment processes
• Document accurately and promptly in clinical software systems
• Process authorizations and coordinate with Medical Directors as needed

Qualifications:

• Nursing degree (ADN, BSN, MSN, or CNL) from an accredited School of Nursing
• Active DC RN License and current Basic Life Support for Healthcare Providers certification
• 3-4 years of Case Management experience
• 3-4 years of Utilization Management or related experience
• 5-7 years of diverse clinical experience
• 3-4 years of acute inpatient care clinical experience

Join our team at V-Tech Solutions and use your nursing expertise to improve healthcare outcomes while growing professionally in a supportive environment. Your skills in care coordination will directly impact the quality of life for the members we serve in the DC community.