Nurse Case Manager II managing complex care needs, assessing and implementing care plans for members in Louisiana. Providing services telephonically or on-site in community settings.
Responsibilities
Responsible for care management within the scope of licensure for members with complex and chronic care needs
Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care
Perform duties telephonically or on-site such as at hospitals for discharge planning
Ensure member access to services appropriate to their health needs
Conduct assessments to identify individual needs and a specific care management plan
Implement care plan by facilitating authorizations/referrals as appropriate
Coordinate internal and external resources to meet identified needs
Monitor and evaluate effectiveness of the care management plan
Interface with Medical Directors and Physician Advisors on care management treatment plans
Negotiate rates of reimbursement as applicable
Requirements
Requires BA/BS in a health related field
Minimum of 5 years of clinical experience
Current, unrestricted RN license in applicable state(s) required
Multi-state licensure is required if providing services in multiple states
Certification as a Case Manager is preferred
Experience with working with the homeless and substance use disorders preferred
Experience with Adult population with Chronic Conditions preferred (e.g., Diabetes, Sickle Cell, Congestive Heart Failure, Hepatitis, HIV, and Hypertension)
Experience in hospital, case management, MCO preferred
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