RN Case Manager
Washington, DC
PRIDE Health
5x8 hrs, Days
Referral Bonus

Case Manager (Registered Nurse) - Washington, DC

Job Details

• Employment Type: Travel/Contract
• Contract Length: 13 weeks
• Shift: Day shift, 5 days a week, 8:00 AM to 4:30 PM (40 hours/week)
• Location: Within 60 miles of Washington, DC area (local candidates only)
• Work Setting: Primarily office-based with possible field visits 2 days per week (mileage reimbursed)
• Dress Code: Business casual
• On Call: None
• Weekend Requirement: None

Job Description

• Manage complex case management for patients with chronic diagnoses such as high-risk pregnancy, postpartum, diabetes, CHF, COPD, asthma, obesity, and behavioral health conditions.
• Conduct comprehensive assessments and develop care plans for enrollees in the Washington DC area.
• Perform ongoing management within the electronic medical record system.
• Utilize care coordination, discharge planning, and admission criteria.
• Apply InterQual Criteria and Milliman Guidelines.
• Regulatory knowledge required including CPT codes, Department of Health DRG, HEDIS measures, NCQA, OSHA procedures, and Joint Commission standards.
• Previous charge nurse experience preferred.
• NCQA experience preferred.
• Position will be based out of a hospital starting May 1.

Required Qualifications

• Valid Registered Nurse (RN) license in the District of Columbia.
• Minimum 2 years of Acute Care Case Management experience, including experience within the last year.
• Associate of Science in Nursing or Associate Degree in Nursing.
• Experience in Long Term Acute Care and Rehabilitation settings.
• Experience in charge nurse roles.
• Basic Life Support (BLS) certification issued by the American Heart Association or American Red Cross.
• Knowledge of CPT codes, Department of Health DRG, HEDIS measures, NCQA, and Joint Commission standards.
• Experience utilizing InterQual criteria and Milliman guidelines.