Job Title:
Patient Care Resource Manager
Job ID:
440559
Location:
Health Plan
Department:
Utilization Management
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
Shift:
Day
FTE %:
100
Salary Range Min:
$55,000.00
Salary Range Max:
$84,750.00

Position summary

Patient Care Resource Manager (Job Opening 440559) - Position Summary: Serves as a service team member who coordinates and evaluates health care delivery for 50,000+ university health plan members and affiliated groups by collaborating with the member?s health care team (comprised of the patient, family, doctor, health care facilities and other related entities outside the health plan) to determine appropriateness of care from diagnosis to outcome; responsible for carrying out the management of specific, individual medical episodes identified through utilization review, and quality assurance functions; uses predictive tools to promote timely preventive personalized and participatory services; helps members identify opportunities for improvement and refers to resources to optimize their efforts; assists in development and implementation of medical guidelines and departmental policies and procedures; works to assure appropriate medical benefit application and claims payments; requires successful completion of a background check.

Education and experience

Bachelor?s Degree or equivalent education/experience?Major-Nursing. Experience in health plan case management; experience in disease case management and wellness programs; experience in acute care setting for patients with complex, chronic and multi-system conditions desired.