case management nurse

HMSA

<div>
 
 Employment Type
 
 
 
 Full-time
 
 
 
 Exempt or Non-Exempt
 
 
 
 Exempt
 
 
 
 Job Summary
 
 
 
 
 Hybrid Work Environment - Must reside in Hawaii
 
 
 
 
 Pay Range:
 
 $59,000 to $116,000
 
 
 
 Note
 
 : Individuals typically begin between the minimum to middle of the pay range
 
 
 Under minimal supervision, conducts detailed analysis and review of precertification requests, post-service and suspended claims, by applying clinical expertise against HMSA medical and reimbursement policies, plan benefits and nationally accepted clinical guidelines to determine appropriateness of care for all HMSA lines of business.
 
 
 
 Minimum Qualifications
 
 
 
 <ul>
 <li>
 Associates degree in Nursing.
 </li>
 <li>
 Current, unrestricted Nursing License in the state of Hawaii as an RN or LPN.
 </li>
 <li>
 Two years clinical, case management or utilization management related experience.
 </li>
 <li>
 Knowledge of current standards of care to be followed for a given diagnosis and the normative values of medical tests and procedures.
 </li>
 <li>
 Strong organizational skills
 </li>
 <li>
 Good communication skills both verbally and written
 </li>
 <li>
 Analytical skills
 </li>
 <li>
 Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook.
 </li>
 <li>
 Currently licensed in Hawaii as an RN or LPN
 </li>
 <ul>
 <li>
 (if applicable upon hire, proof of licensure to be provided by employee or confirmed by Human Resources)
 
 </li>
 </ul>
 </ul>
 
 Duties And Responsibilities
 
 
 
 <ul>
 <li>
 Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes evaluating whether the requested service is a covered benefit under the member's health plan, is medically appropriate for the member's clinical condition or whether the request requires referral to a Medical Director for potential denial of the request. The Nurse Reviewer must follow each line of business' requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each request. Assists on inquiries from external parties such as the State Insurance Commissioner and from the Legal Department. Responsibilities include, but are not limited to:
 </li>
 <ul>
 <li>
 Demonstrate understanding and application of over 250 Guide to Benefits, Evidence of Coverage, Plan Brochure, and Member Handbook. HMSA annually updated medical and drug policies, medical protocols, National Comprehensive Cancer Network, Milliman Care Guidelines, Drugdex, etc. to determine the medical necessity of urgent and non-urgent precertification requests. Urgent requests must be completed within 72 hours and non-urgent requests within 15 calendar days.
 </li>
 <li>
 Use clinical judgment, medical necessity guidelines and plan benefits to determine approval, potential denial or alternative treatment of each urgent or non-urgent precertification request. Settings include inpatient, outpatient, in-state, out-of state and out-of country.
 </li>
 <li>
 Document clinical case summary and review outcome of each review appropriately to meet regulatory and program requirements.
 </li>
 <li>
 Review various types of services, including but not limited to:
 </li>
 <li>
 Transplants
 </li>
 <li>
 Air Ambulance
 </li>
 <li>
 Chemotherapy
 </li>
 <li>
 Clinical trials
 </li>
 <li>
 Genetic testing
 </li>
 <li>
 Cancer treatments/radiation therapy
 </li>
 <li>
 Experimental/Investigational Services/Devices
 </li>
 <li>
 New Technology
 </li>
 </ul>
 <li>
 Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes evaluating whether the requested service is a covered benefit under the member's health plan, is medically appropriate for the member's clinical condition or whether the request requires referral to a Medical Director for potential denial of the request. The Nurse Reviewer must follow each line of business' requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each request. Assists on inquiries from external parties such as the State Insurance Commissioner and from the Legal Department. Responsibilities include, but are not limited to:
 </li>
 <ul>
 <li>
 Call providers when additional clinical information is required to clarify or complete a complex precertification determination.
 </li>
 <li>
 Approve precertification requests based on clinical judgment using criteria, medical record documentation and other information received from the provider.
 </li>
 <li>
 Consult with Medical Directors on requests which do not meet clinical criteria and offer alternative covered health care options as appropriate.
 </li>
 <li>
 Consult Medical Directors on potential quality issues identified during review of medical records. Refer cases to Integrated Health Management, Pharmacy Department or Benefits Integrity Department depending on the concern.
 </li>
 </ul>
 <li>
 Evaluate suspended claims against medical records to determine the medical necessity and appropriateness of medical services, identify irregularities such as over or under-utilization of services, potential up-coding, over billing, etc.
 </li>
 <li>
 Communicate timely, accurate information either verbally, electronically or in writing using clinical judgment, knowledge of medical/reimbursement policies and plan benefits to providers, members as well as internal MM staff and other internal departments (Claims Administration, Customer Relations, Provider Contracting, etc.). For denied services, ensure the denial, benefit and appeal language are accurate and consistent with department procedures, accreditation and regulatory guidelines.
 </li>
 <li>
 Identify and refer members with specific medical and/or behavioral health needs or complex case management and collaborate with medical and behavioral case management staff. Identify and refer quality of care issues and suspected fraud, waste or abuse to the appropriate departments.
 </li>
 <li>
 Perform pre-screening assessment of incoming pre-certification requests to ensure appropriateness of review. Advises non-clinical staff on clinical and coding questions to ensure correct system processes and entries.
 </li>
 <li>
 Performs all other miscellaneous responsibilities and duties as assigned or directed.
 
 
 </li>
 </ul>
</div>

Nurse Reviewer - Clinical Review Unit

US Department of Veterans Affairs

Outpatient Staff Registered Nurse - Patient Aligned Care Team (PACT)

Strive Health

<div>
 
 What We Strive For
 
 
 
 At Strive Health, we&rsquo;re driven by a purpose: transforming the broken kidney care system. Through early identification, engagement, and comprehensive coordinated care, we significantly improve outcomes for people with kidney disease, reducing emergency dialysis and inpatient utilization. Our high-touch care model integrates with local providers and uses predictive data to identify and support at-risk patients along their entire care journey. We embrace diversity, celebrate successes, and support each other, making Strive the destination for top talent in healthcare. Join us in making a real difference.
 
 
 
 Benefits &amp; Perks
 
 
 
 <ul>
 <li>
 Hybrid-Remote Flexibility &ndash; Work from home while fulfilling in-person needs at the office, clinic, or patient home visits.
 </li>
 <li>
 Comprehensive Benefits &ndash; Medical, dental, and vision insurance, employee assistance programs, employer-paid and voluntary life and disability insurance, plus health and flexible spending accounts.
 </li>
 <li>
 Financial &amp; Retirement Support &ndash; Competitive compensation with a performance-based discretionary bonus program, 401k with employer match, and financial wellness resources.
 </li>
 <li>
 Time Off &amp; Leave &ndash; Paid holidays, vacation time, sick time, and paid birthgiving, bonding, sabbatical, and living donor leaves.
 </li>
 <li>
 Wellness &amp; Growth &ndash; Family forming services through Maven Maternity at no cost and physical wellness perks, mental health support, and an annual professional development stipend.
 </li>
 <li>
 Up to a $10k sign-on bonus currently offered for hires in this position **
 
 
 
 </li>
 </ul>
 
 What You&rsquo;ll Do
 
 
 
 As part of Strive&rsquo;s interdisciplinary clinical care team, the Nurse Practitioner (NP) will utilize their advanced education, skills, and judgment to deliver advanced nursing care for CKD and ESKD patients. The NP will be responsible for managing patient care by working with the Strive interdisciplinary team of social workers, care coordinators, pharmacists, dietitians, and physicians to provide best in class patient care. The Strive NP will be an advocate, navigator, trusted clinician, and safety net for the patient while delivering exceptional clinical care, building empathy and trust with patients, and delivering a world class patient experience. This position reports to the Senior Manager, Nurse Practitioner.
 
 
 
 The Day To Day
 
 
 
 <ul>
 <li>
 Accountable for patient outcomes and KPI&rsquo;s for a panel of CKD and ESKD patients. Collaborates with external providers to ensure goals, treatment, and care plan alignment.
 </li>
 <li>
 Obtains patient history, performs physical exam, orders and interprets diagnostic tests and formulates a plan for individual patient short-term and longitudinal needs.
 </li>
 <li>
 Presents patient cases and provides clinical support for clinical rounds and interdisciplinary team meetings.
 </li>
 <li>
 Ensures assessment and plan of care incorporate best practices for chronic kidney care including CKD clinical care (management of all stages of CKD, co-morbidities, ESKD and support of transitions to renal replacement therapy, transplant, or conservative care) as well as participation in shared decision-making and end-of-life/advanced care planning discussions.
 </li>
 <li>
 Serves patients and performs patient visits in multiple care settings as defined by role, including patient home, clinics (where applicable), partner MD space (where applicable), and via telehealth/virtual visits.
 </li>
 <li>
 Serves as a liaison with dialysis facilities, PCPs, and nephrologists, providing care plan updates to help streamline the transitions in care.
 </li>
 <li>
 Responsible for maintaining current board certification and state-specific continuing education requirements.
 </li>
 <li>
 Adheres to expectations outlined in Strive&rsquo;s documentation policy
 </li>
 <li>
 Deliver primary and urgent care visits to adult and geriatric patients with history of chronic kidney disease (in designated markets)
 </li>
 <li>
 Provides in-person patient care which may include standing, sitting, walking, pushing, pulling, and lifting.
 
 
 
 </li>
 </ul>
 
 Minimum Qualifications
 
 
 
 <li>
 Master&rsquo;s degree in Nursing or similar field.
 </li>
 <li>
 2+ years experience as a Family Nurse Practitioner (NP), Primary Care Nurse Practitioner (NP), or experience in internal medicine, cardiology, Nephrology or Case Management.
 </li>
 <li>
 Current state specific licensure required.
 </li>
 <li>
 National Board Certification.
 </li>
 <li>
 Current Drug Enforcement Administration (DEA) license required or eligible to obtain within 90 days of hire.
 </li>
 <li>
 Current BLS or CPR Certification required.
 </li>
 Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency
 <li>
 Efficient and reliable transportation, including an active driver&rsquo;s license, allowing for travel across an assigned region to meet patient needs. Locations may include offices, clinics, and patient homes.
 </li>
 <li>
 Ability to work Tues-Sat: 8a-5p.
 </li>
 <li>
 Please note: Strive&rsquo;s new hire orientation schedule is 10:00am - 5:00pm EST for 14 days, with three sessions lasting an additional 30 minutes. Therefore, the hours will align to that schedule for this initial period.
 
 
 </li>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Basic computer and Microsoft Office skills.
 </li>
 <li>
 2+ years experience with Electronic Health Records (EHR) preferred.
 </li>
 <li>
 Wound Care certification preferred.
 </li>
 <li>
 Experience using audio-visual technology platforms.
 
 
 
 </li>
 </ul>
 
 About You
 
 
 
 <ul>
 <li>
 Demonstrated proficiency in clinical assessment, diagnosis, planning, implementation, documentation, and evaluation of complex chronic patients.
 </li>
 <li>
 Excellent communicator, team builder, and evidence of results.
 </li>
 <li>
 Demonstrated knowledge and understanding of data and managing clinical, financial, and patient satisfaction outcomes.
 </li>
 <li>
 Excels at developing and fostering strong patient and family relationships that center on engagement, trust, honesty, empathy, follow-through and doing what&rsquo;s best for the patient.
 
 
 
 </li>
 </ul>
 
 Annual Salary Range:
 
 $117,600.00-$147,000.00 *This range is inclusive of a 5% pay differential due to the alternative shift hours
 
 
 Strive Health is an equal opportunity employer and drug free workplace. At this time Strive Health is unable to provide work visa sponsorship. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. Please apply even if you feel you do not meet all the qualifications. If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talentacquisition@strivehealth.com.
 
 
 
 We do not accept unsolicited resumes from outside recruiters/placement agencies. Strive Health will not pay fees associated with resumes presented through unsolicited means.
 
 
 
</div>

Nurse Practitioner (Tues-Sat: 8a-5p)

Enlyte

<div>Company Overview:
<div>
At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.</div><div></div><div> 
Be part of a team that makes a real difference.</div>
Job Description:
<div>
This is a full-time, hybrid position. The candidate must be located in the Albuquerque, New Mexico area due to regular local travel for in-person patient appointments.</div><div>
Bilingual (English/Spanish) Required.</div><div></div><div> 
Perks: Full and comprehensive benefits program, 24 days of paid vacation/holidays in your first year plus sick days, home office equipment including laptop and desktop monitor, mileage and travel reimbursement, Employee Assistance and Referral Program, and hands-on workers&rsquo; compensation case management training.</div><div></div><div> 
Join our compassionate team and help make a positive difference in an injured person&rsquo;s life. As a Field Case Manager, you will work closely with treating physicians/providers, employers, customers, legal representatives, and the injured/disabled person to create and implement a treatment plan that returns the injured/disabled person back to work appropriately, ensure appropriate and cost-effective healthcare services, achievement of maximum medical recovery and return to an optimal level of work and functioning. In this role, you will:</div><ul><li>
Demonstrate knowledge, skills, and competency in the application of case management standards of practice.
</li><li>Use advanced knowledge of types of injury, medications, comorbidities, treatment options, treatment alternatives, and knowledge of job duties to advise on a treatment plan.</li><li>
Interview disabled persons to assess overall recovery, including whether injuries or conditions are occupational or non-occupational.</li><li>
Collaborate with treating physicians/providers and utilize available resources to help create and implement treatment plans tailored to an individual patient.</li><li>
Work with employers and physicians to modify job duties where practical to facilitate early return to work.</li><li>
Evaluate and modify case goals based on injured/disabled person&rsquo;s improvement and treatment effectiveness.</li><li>
Independently manage workload, including prioritizing cases and deciding how best to manage cases effectively.
</li><li>Complete other duties, such as attend injured worker&rsquo;s appointments when appropriate, prepare status updates for submittal to customers, and other duties as assigned.</li></ul>
Qualifications:
<ul><li>Education: Associates Degree or Bachelor&rsquo;s Degree in Nursing or related field.</li><li>
Experience: 2+ years clinical practice preferred. Workers&rsquo; compensation-related experience preferred.</li><li>
Skills: Ability to advocate recommendations effectively with physicians/providers, employers, and customers. Ability to work independently. Knowledge of basic computer skills including Excel, Word, and Outlook Email. Proficient grammar, sentence structure, and written communication skills.</li><li>
Certifications, Licenses, Registrations:
<ul><li>Active Registered Nurse (RN) license required. Must be in good standing.</li><li>
URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN, COHN-S, RN-BC, ACM, CMAC, CMC) preferred.</li></ul></li><li>
Travel: Must have reliable transportation and be able to travel to and attend in-person appointments with injured workers in assigned geography.</li><li>
Internet: Must have reliable internet.</li></ul>
Benefits:
<div>
We&rsquo;re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&amp;D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $73,000 - $83,000 annually. In addition to the base salary, you will be eligible to participate in our productivity-based bonus program. Your total compensation, including base pay and potential bonus, will be based on a number of factors including skills, experience, education, and performance metrics.</div><div> 
</div>The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
#LI-AC1<div></div><div> 
Registered Nurse (RN), Nursing, Home Care Registered Nurse, Emergency Room Registered Nurse, Clinical Nurse, Nurse Case Manager, Field Case Manager, Medical Nurse Case Manager, Workers&rsquo; Compensation Nurse Case Manager, Critical Care Registered Nurse, Advanced Practice Registered Nurse (APRN), Nurse Practitioner, Case Management, Case Manager, Home Healthcare, Clinical Case Management, Hospital Case Management, Occupational Health, Patient Care, Utilization Management, Acute Care, Orthopedics, Rehabilitation, Rehab, CCM, Certified Case Manager, CDMS, Certified Disability Management Specialist, CRC, Certified Rehab Certificate, CRRN, Certified Rehab Registered Nurse, COHN, Certified Occupational Health Nurse, CMC, Cardiac Medicine Certification, CMAC, Case Management Administrator Certification, ACM, Accredited Case Manager, MSW, Masters in Social Work, URAC, Vocational Case Manager</div></div>

Bilingual Field Case Manager

Your Health

<div>
 Back to Job Openings
 
 
 Nurse Case Manager - Registered Nurse
 
 
 Greenville SC, Lyman SC, Greer SC
 
 
 Apply
 
 
 Share
 
 
 
 We are seeking Registered Nurse to service our patients throughout the Greenville area.
 
 The role of the Nurse Case Manager position is a critical part of the patient&rsquo;s care team. The nurse will visit patients and facilitate with appropriate provider. The Nurse Case Manager will be required to travel to patients&rsquo; homes, long-term care facilities, etc. to evaluate patients and initiate telemedicine visits. Provide quality healthcare in adherence to all applicable laws, regulations, and policies within the scope of practice.
 
 
 
 Nurse Case Manager's perform visits in homes and facilities (ALF and ILF's) in their designated service area
 
 .
 
 You must have reliable transportation as travel is required daily.
 
 This is a full time, salary-based working 8-hr shifts Monday-Friday (8am-5pm)
 
 
 
 The Following Service Area(s) Are Currently Available
 
 
 
 <ul>
 <li>
 Greenville area
 
 
 </li>
 </ul>
 
 About
 
 
 
 We are a leading physician group serving South Carolina and Georgia, dedicated to delivering quality healthcare directly to patients in care facilities, homes, clinics, and virtual visits. Our services include comprehensive primary care, specialty services, and pharmacy support, tailored to meet diverse patient needs. Committed to excellence and innovation, our team collaborates closely with facilities and families to ensure accessible, coordinated, and compassionate care.
 
 
 
 Why Choose a Career at Your Health?
 
 
 
 Providing high quality care for our patients is the center of what we do, and we provide the same care for our employees. Here are some of the benefits that are available to our employees.
 
 
 <ul>
 <li>
 Competitive Compensation Package with Bonus Opportunities
 </li>
 <li>
 Employer Matched 401K
 </li>
 <li>
 Free Visit &amp; Prescriptive Services with HDHP Insurance Plan
 </li>
 <li>
 Employer Matched HSA
 </li>
 <li>
 Generous PTO Package
 </li>
 <li>
 Career Development &amp; Growth Opportunities
 </li>
 <li>
 Vehicle allowance
 
 
 </li>
 </ul>
 
 What Are We Looking For?
 
 
 
 Your Health is currently looking for a Registered Nurse to join our growing primary care family. A successful Nurse Case Manager will be able to perform these essential duties and responsibilities. Reasonable accommodations may be made, in accordance with applicable law, to enable individuals with disabilities to perform the essential functions.
 
 
 The following is a list of essential functions, which may be subject to change at any time and without
 
 
 notice. Management may assign new duties, reassign existing duties, and/or eliminate function(s).
 
 
 
 Area Of Responsibility
 
 
 
 <ul>
 <li>
 Facilitate receiving all medical records from the patient&rsquo;s primary provider and specialists.
 </li>
 <li>
 Review medical records.
 </li>
 <li>
 Complete consents with patients.
 </li>
 <li>
 Enroll patients in Care Management, if they meet eligibility criteria.
 </li>
 <li>
 Initiate a Care Management Plan of Care, if the patient is eligible.
 </li>
 <li>
 Capture all diagnoses at the highest specificity by creating gaps and ensure they are accepted.
 </li>
 <li>
 Complete AWV&rsquo;s to be reviewed by the provider.
 </li>
 <li>
 Complete cognitive impairment screenings.
 </li>
 <li>
 Complete Social Determinants of Health (SDoH) assessments and/or screenings.
 </li>
 <li>
 Complete ACP&rsquo;s to be reviewed with the patient by the provider.
 </li>
 <li>
 Evaluate for home health, hospice, palliative, or consults with Your Health Specialty Division, etc.
 </li>
 <li>
 Evaluate for RPM devices, resources, or tools that may improve the patient&rsquo;s quality of life.
 </li>
 <li>
 Communicate and coordinate care.
 </li>
 <li>
 Reconcile prescribed and OTC medications, vitamins, supplements, herbal remedies, and other treatments.
 </li>
 <li>
 Provide post-discharge education.
 </li>
 <li>
 Evaluate for adaptive equipment and DME.
 </li>
 <li>
 Evaluate for safe environment.
 </li>
 <li>
 Evaluation of acute condition(s) or follow-up from previous visit.
 </li>
 <li>
 Appropriately and accurately document and log Care Management activities. Work in conjunction with care team to keep the patients Care Management care plans up to date.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Must be a licensed nurse. Registered nurse preferred. License must be in good standing with appropriate board/issuer.
 </li>
 <li>
 A minimum of three (3) years clinical experience preferred.
 </li>
 <li>
 Experience in community settings preferred.
 </li>
 <li>
 Proven ability to effectively communicate and collaborate with interdisciplinary care teams, patients, and caregivers.
 </li>
 <li>
 Strong written and verbal skills.
 </li>
 <li>
 Basic computer knowledge.
 </li>
 <li>
 Ability to manage and demonstrate effective leadership skills.
 </li>
 <li>
 Should demonstrate good interpersonal and communication skills under all conditions and circumstances.
 </li>
 <li>
 Ability to foster a cooperative work environment.
 </li>
 <li>
 Team player with ability to manage multiple responsibilities and demonstrate sound judgment.
 </li>
 <li>
 Must be able to work flexible hours and travel between offices, facilities, etc. Must be a licensed driver with an automobile that is insured in accordance with state and/or organizational requirements and is in good working order
 
 
 </li>
 </ul>
 Apply
</div>

Nurse Case Manager - Registered Nurse

Paradigm

<div>
 
 We&rsquo;re
 
 proud
 
 to be recognized&mdash;again! For the fourth year in a row, we&rsquo;ve been certified by
 
 Great Place to Work
 
 &reg;,
 
 
 and for the third consecutive year, we&rsquo;ve earned a spot on Fortune's Best Workplaces in Health Care&trade; list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.
 
 
 
 
 
 The Surprising Truth About Case Management - Paradigm
 
 
 
 
 
 Watch this short video for a brief introduction to role of a nurse case manager at Paradigm.
 
 
 
 
 
 We are seeking an
 
 experienced Nurse Case Manager
 
 interested in working with injured workers and worker&rsquo;s compensation cases to cover
 
 Los Angeles
 
 and surrounding communities. This
 
 role is a home-based position with travel, up to 2 hours one-way (4 hours round-trip), to doctors&rsquo; offices, hospitals, and various other locations.
 
 
 
 This individual is responsible for the medical case management of work-related injuries, which includes assessment, planning, coordination, implementation, and evaluation of injured/disabled individuals. The Case Manager works with insurance carriers, medical care providers, attorneys, employers, and employees, and closely monitors the progress of the injured worker and reports results back to the employer and insurance carriers.
 
 
 
 
 
 
 At Paradigm, People Come First
 
 
 
 It's more than a job. It's a passion. Work at Paradigm, and you&rsquo;ll find deep satisfaction knowing you&rsquo;re making a profound difference in people&rsquo;s lives.
 
 <ul>
 <li>
 Meaningful work: better outcomes for all isn&rsquo;t just our tagline. It&rsquo;s what guides us to do our best&mdash;every day. At Paradigm, you&rsquo;ll find an authentic connection between the work you do and your passion for making a difference in the world.
 </li>
 <li>
 Exceptional people: You'll work alongside smart people who share a commitment to excellence and a dedication to service. We're not here just for a "job." We're here to transform lives.
 </li>
 <li>
 Collaborative culture: At Paradigm, a spirit of collaboration and care is evident in everything we do. We promote a culture of inclusivity and value diversity of all kinds including thought, knowledge, and experience. No matter the team, everyone works together toward a common goal to deliver exceptional outcomes.
 </li>
 </ul>
 
 
 
 
 
 Qualifications
 
 
 <ul>
 <li>
 Current, unencumbered registered nurse (RN) license in CA
 </li>
 <li>
 Experience in worker&rsquo;s compensation catastrophic case management is preferred. Experience may include:
 </li>
 <li>
 Critical care experience, catastrophic injury/illness case management, and/or disability management
 </li>
 <li>
 Clinical experience in acquired brain injury, spinal cord injury, multiple trauma (including amputation), and/or burns
 </li>
 <li>
 Recommended certifications (CCM, CRRN, CDMS, CRC). REQUIRED within two years of the date of hire
 </li>
 <li>
 Ability to occasionally work outside of traditional business hours (evenings or weekends) if needed to meet the needs of the claim
 </li>
 <li>
 Skills needed: organization and timeline adherence; PC and technology; communication (written, verbal and interpersonal)
 </li>
 <li>
 Valid driver&rsquo;s license, and good driving history
 </li>
 </ul>
 
 
</div>

Catastrophic / Field Nurse Case Manager

Sidra

<div>JOB SUMMARY
The Clinical Nurse Manager - Homecare and Case Management has 24-hour operational accountability for all clinical, operational and budget responsibility of the Case Management and homecare units incorporating the hospitals vision and strategic plan. The Clinical Nurse Manager - Case Management and Homecare directs and coordinates clinical planning activities for both services and is responsible for the recommendation, development and implementation of case management and homecare procedures, standards and guidelines, and for keeping the Director of Nursing informed of progress and potential problems. As a key member of the hospital&rsquo;s senior nursing management team the incumbent assumes accountability for the overall management and the delivery of quality Nursing Services to achieve optimal patient experience and outcomes for the service delivery area. S/he ensures that standards for case management and homecare are adhered to. The incumbent is fully responsible for the Case Management and Homecare unit budgets, patient experience and outcomes and staff performance and development. S/he works collaboratively to ensure that commissioning, recruitment, onboarding, orientation and service activation responsibilities are carried out in accordance with Sidra&rsquo;s plans and timelines. The Clinical Nurse Manager - Homecare and Case Management is professionally accountable to the Chief Nursing Officer.
QUALIFICATIONS, EXPERIENCE AND SKILLS &ndash; SELECTION CRITERIA
EDUCATION
Essential:
<ul><li>Bachelor Degree in Nursing (4 years)
</li><li>Master&rsquo;s degree in Nursing or health related field, or Masters in Business Administration
</li><li>Registered Nurse
</li></ul>Preferred:
<ul><li>Master&rsquo;s degree in Nursing or health related field, or Masters in Business Administration
</li><li>Post graduate specialty qualification/certification
</li></ul>EXPERIENCE
Essential:
<ul><li>7+ years of clinical experience including 5+ progressive management experience within the relevant specialty area in an acute care hospital Experience in an Academic Medical Center
</li></ul>Preferred:
<ul><li>Demonstrated experience with clinical Information systems
</li><li>Hospital Commissioning
</li><li>Previous accreditation experience
</li><li>Evidence of publications / presentations in the past 5 years
</li></ul>CERTIFICATION &amp; LICENSURE
Essential:
<ul><li>Valid professional nursing license in country of origin
</li><li>Case Manager Certification from an accredited national organization
</li><li>Meets licensing requirements of the State of Qatar
</li></ul>PROFESSIONAL MEMBERSHIP
Preferred:
Member of a professional nursing association 
<ul><li>
</li></ul>JOB SPECIFIC SKILLS &amp; ABILITIES 
Essential:
<ul><li>Proactive approach to planning
</li><li>Demonstrated ability to cope with rapid and sustained change, competing demands and tight deadlines
</li><li>Demonstrated ability to develop and maintain effective relationships with a range of stakeholders internally and externally
</li><li>Effective communication and presentation skills and demonstrated ability to present to large audiences.
</li><li>Empowering and enabling leadership style
</li><li>Effective coordination of resources to maintain safe patient care
</li><li>Proficiency with Microsoft Office suite
</li><li>Fluency in written and spoken English
</li></ul>Preferred:
<ul><li>Arabic speaking and/or bilingual in other languages
</li></ul>KEY ROLE ACCOUNTABILITIES
<ul><li>Formulates, communicates and oversees the implementation of the case management and national homecare strategy in collaboration with key stakeholders.
</li><li>Develops, directs and ensures continuous improvement to the implementation of operational plans for case management and homecare.
</li><li>Makes decisions on budget planning, clinical operation, resource allocation and staff performance for case management and homecare units.
</li><li>Ensures all nursing staff work within their scope of practice and within QCHP licensure of Qatar.
</li><li>Implements patient experience and quality plans for homecare and case management.
</li><li>Translates the pediatrics nursing strategy into plans for case management and homecare and drives their execution.
</li><li>Leads and coordinates collaborative multi-disciplinary partnerships working towards the achievements of constant improvement in quality patient care and patient experience.
</li><li>Assumes accountability and oversight for patient experience and clinical outcomes for the Case Management and Homecare units.
</li><li>Continually reviews nursing practice to ensure that the most effective research based and timely care is provided for patients and their families. Addresses any issues that negatively impact on patient care outcomes.
</li><li>Develops goals, KPIS and objectives for Case Management and Homecare in collaboration with the Director and other key stakeholders by embracing evidence and research to support transformational changes.
</li><li>Ensures that patient care is provided in accordance with established case management and standards of nursing care, accreditation, policies, guidelines and protocols of Sidra and the State of Qatar.
</li><li>Develops and implements processes to ensure authorization of appropriate services for continued stay and during discharge.
</li><li>Plans for resource allocation that meets patient population needs. Ensures staffing ratios and patient assignments are reflective of patient census, acuity, level of education, and capabilities of staff.
</li><li>Assumes financial responsibility through budget management for the unit to ensure that patient services are provided in a timely, efficient and effective manner. Balances financial responsibility against safe patient care.
</li><li>Manages ongoing individual performance appraisals, development plans and professional goals for case management and homecare staff members.
</li><li>Leads, plans, implements and evaluates the operational care delivery for case management and homecare.
</li><li>Achieves goals and objectives by embracing evidence and research to support transformational changes.
</li><li>Sets and monitors performance standards against patient outcomes.
</li><li>Monitors and implements the comprehensive unit based safety program takes corrective action as required.
</li><li>Establishes and analyzes areas of improvement through data to prepare necessary reports.
</li><li>Develops, reviews and revises unit procedures as required.
</li><li>Leads and participates in organization-wide performance improvement activities and committees as assigned.
</li><li>Provides support for Shared Governance for case management and homecare.
</li><li>Partners with clinical educators in planning, implementation and evaluation of patient and staff education requirements.
</li><li>Drives the implementation of patient experience principles, provides service recovery, and identifies and implements continuous improvement opportunities as required.
</li><li>Monitors and analyzes performance data to ensure that unit KPIs are achieved, identifies opportunities for improvement and implements solutions.
</li><li>Leads and manages the selection, development and retention of all staff within the unit
</li><li>Serves as a professional and clinical role model for staff and acts as an advocate for patients and their families
</li><li>Promotes positive staff morale by building and maintaining relationships.
</li><li>Ensures clinical practitioner competence and professional nursing credibility.
</li><li>Deputizes for the Director of Nursing as required.
</li><li>Adheres to Sidra&rsquo;s standards as they appear in the Code of Conduct and Conflict of Interest policies
</li><li>Adheres to and promotes Sidra&rsquo;s Values
</li></ul>In view of the evolving needs and opportunities within Sidra, this position may be required to perform other duties as assigned and reporting relationships may vary.</div>
 <div><div>About US</div>
<div><div>Sidra Medicine a healthy population is essential to a strong, prosperous society, and throughout 2020, Sidra continued to provide uninterrupted comprehensive specialist healthcare services for children and young people; and exceptional maternity, gynecology, and reproductive medical services for women, previously unavailable in Qatar and the region.&rdquo; &ndash; H.H Sheikha Moza bint Nasser, Chairperson of Qatar Foundation
</div><div>Sidra Medicine represents the vision of Her Highness Sheikha Moza bint Nasser who serves as its Chairperson. This high-tech facility is home to world-class patient care, scientific expertise, and educational resources.</div></div></div><div></div>

Clinical Nurse Manager - Homecare and Case Management

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