RN Case Manager DC Chartered Health Plan Washington, DC

The RN Case Manager, Children with Special Needs spends approximately 80% of the work time completing member assessments, creating member-specific care plans, attending patient- specific meetings, and managing member care coordination, and the remaining 20% of the work time preparing and reviewing completed reports, participating in case rounds, and facilitating Team interaction and workflow among each other and coordination with Behavioral Health staff, the Social Worker, and other areas as necessary. DC Chartered Health Plan, Inc. is the oldest and largest Medicaid Managed Care Organization in the Nation's Capital. We currently serve over 100,000 Medicaid eligible and uninsured residents in the District of Columbia. The National Committee for Quality Assurance (NCQA) awarded Chartered an accreditation status of commendable for service and clinical quality that meet NCQA's rigorous requirements for consumer protection and quality improvement. Our medical management department is undergoing transformational change. Key strategies include enhancing our support for members through partnerships with community-based organizations, leveraging innovative technology, and re-defining our relationship with providers to include ensuring that they have a comprehensive snapshot of the patient’s clinical profile at the point of care. We are listening to our members, providers and community partners in order to learn about best practices, so that we can leverage the best of what we do along with the expertise of our partners. By joining this team you will be a key contributor to our change process. We are seeking candidates who are interested in a temporary position of 30-40 hours per week. The position involves a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes for children with special needs as mandated by the MAA contract. • Act as DC Chartered Health Plan’s liaison to MAA and other public and private programs to coordinate care for children with special needs. • Coordinates the CAHMI survey and evaluation program working with internal and external resources to insure children age 0-18 are assessed, evaluated, and referred for appropriate disease or case management and care coordination. • Coordinate, evaluate, and monitor care services from all care providers whether PAR or non-PAR. Negotiate appropriate reimbursement for services and equipment for non-PAR providers. • Approve medically necessary services and equipment that require prior authorization for reimbursement utilizing the appropriate medical criteria. • Participate in case rounds and other care management meetings, presenting clinical information on current cases, identifying potential cases for case management and service review, and coordinating care with other Medical Management team members.

Join our team of dedicated professionals who are improving the health of the individuals we serve. Visit www.chartered-health.com to learn more and send resumes to: lbulls@chartered-health.com or mail: D.C. Chartered Health Plan ATTN: Human Resources 1025 15th Street, NW Washington, DC 20005

An Equal Opportunity Employer

• Registered Nurse with current, valid unrestricted licensure to practice nursing in the District of Columbia, Maryland or Virginia, a must; with Neonatal Intensive Care or Pediatric acute care experience. • Experience with Children with Special Needs programs preferred • Bachelor’s degree in nursing (BSN) preferred • Master of Science Nursing (MSN) or master of Public Health Degree (MPH) a plus • Five (5) years clinical management experience in the nursing areas of Utilization Management, Quality Management, Risk Financing experience in a managed care environment required. • Knowledge of applicable state, federal guidelines, third party regulations and standards for Medicaid, Medicare, NCQA, URAC; CMSA preferred. . • Prior experience working with Medicaid, Medicare recipients or underserved population strongly desired. • Previous working experience and competency utilizing InterQual criteria required. • Must possess working knowledge of utilization review standards and be knowledgeable regarding medical terminology and ICD-9 CM coding. • Certified Professional Utilization Review / Management Certification (CPUR, / CPUM and / or CCM) preferred. • Competent in computer skills including MS Word, Excel, and Access.