Develop, assess and adjust, as necessary, the care plan and promote desired outcome.
Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment and provider options.
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients.
Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs.
Provide patient and provider education.
Facilitate members’ access to community-based services.
Monitor referrals made to community-based organizations, medical care and other services to support the members’ overall care management plan.
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources.
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems Monitor referrals made to community-based organizations, medical care and other services to support the members’ overall care management plan.
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources.
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems, treatment and provider options.
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients.
Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs.
Provide patient and provider education.
Facilitate members’ access to community-based services.
Monitor referrals made to community-based organizations, medical care and other services to support the members’ overall care management plan.
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources.
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
Education/Experience
Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred.
2+ years of clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.
Licenses/Certifications
Current state’s RN license.
Describe the performance expectations/metrics for this individual and their team:
Calls are audio recorded and cases are monitored closely.
What previous job titles or background work will be in this role?
Case Manager, Transitions of Care, Utilization Management, Disease Management
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Staffing and Recruiting
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