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Telligen

Healthcare quality improvement and management services

Nurse Care Manager - RN

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeNo salary listed

About the Job

Requirements

  • A four-year degree in health care or a related field, or equivalent training or experience.
  • At least 1 year of experience in human services and/or 3 years of clinical practice experience.
  • Licensure as a health care provider or a current RN license; some contracts may require state-specific licensure, and state licensure may be required for different clients in numerous states.
  • Certain positions may require advanced certifications or the ability to obtain certifications within 4 years.

Responsibilities

  • Manage care for patients with acute and chronic medical conditions and assess care needs of vulnerable populations for various clients.
  • Assess and evaluate potential care management patients according to client contractual obligations and/or state requirements.
  • Collaborate with health care providers and ancillary service providers to validate appropriate treatment plans and identify educational opportunities.
  • Conduct assessment or education through face-to-face interaction for specific contracts when required.
  • Guide members to appropriate member benefit information.
  • Provide ongoing education.
  • Communicate with health care providers to ensure appropriateness of care.
  • Recommend and make adjustments in care when needed.
  • Evaluate treatment adherence and reevaluate patients’ commitment to make necessary changes.
  • Document individual member status and/or medical necessity review and negotiation according to contractual requirements.
  • Escalate issues through appropriate channels, following established hierarchical protocols between clinical and non-clinical staff members.
  • Perform other duties as assigned.

About the Company

Telligen

Healthcare quality improvement and management services

Telligen is a healthcare management and quality improvement company that partners with U.S. government health agencies, state Medicaid programs, self-funded employer and Taft-Hartley plans, and managed care organizations to improve health outcomes through data analytics and clinical management. Its services span quality measurement and reporting, case and utilization management, chronic-condition and specialty health management, and wellness programs such as the National Diabetes Prevention Program, many delivered through its Qualitrac platform with modules for case management, quality measurement, utilization management, and PASRR. What sets Telligen apart is its pairing of proprietary technology with clinical expertise, backed by NCQA Population Health Program Accreditation and industry recognition. The goal is to help people live their healthiest lives by improving outcomes with proven management solutions.

Company size
Not listed
Company stage
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Total funding
Not listed
Headquarters
London, United Kingdom
Founded
Not listed

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