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RN Care Manager in Charleston, WV at KEPRO

Date Posted: 3/9/2018

Job Snapshot

Job Description


RN Care Manager

Perform utilization management tasks, provider training and technical assistance for WV Medicaid behavioral health providers.  The RN will make medical necessity determinations regarding acute inpatient and outpatient behavioral health services, communicate with physicians, and attend case related meetings.  The applicant will utilize national and local guidelines, perform research on best practices, and displays effective organizational skills to meet contract deliverables.  This position will also support the I/DD Waiver program. 


  • Medical necessity determination according to utilization guidelines and WV

DHHR policy.

  • Provide excellent customer service, daily communication with providers and

contractors, and data completion.

  • Communication with providers related to coordination of care
  • Interface with staff and contractors regarding provider concerns, development of review criteria and utilization management resources.
  • Perform job functions within established time frames, participates in team quality review activities and meets performance metrics.
  • Assist with authorization of I/DD Waiver services.
  • Perform activities to support other KEPRO programs as needed.
  • The position has the opportunity to transition to work in a home office after six months.


  • Associates degree in Nursing
  • Active and unrestricted WV RN license
  • Minimum 1-2 years’ experience in providing behavioral health and I/DD Waiver services.   
  • Demonstrated experience with MS Office – specifically Word and Excel

•     Excellent customer service, written/verbal communications and organizational skills to meet


  • Ability to review/analyze documentations against set standards
  • Ability to adequately communicate findings and recommendations to providers verbally and

in written format.

  • Ability to work independently to meet timelines and expectations
  • Ability to interact appropriately with providers under stressful and/or changing condition

  • Equal Opportunity Employer


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